[Congestive cardiomyopathy: value of short and long-term vasodilator treatment and prognosis]

Vasodilator therapy in congestive heart failure has proven an effective adjunct to conventional treatment with digitalis and diuretics. In this study dipyridamole was used in combination with isosorbide dinitrate to treat twelve patients (mean age 55 years) with idiopathic congestive cardiomyopathy. All patients were in N.Y.H.A. class III or IV and were already treated with digitalis and diuretics. This conventional therapy was not discontinued for the study. Acute studies were performed during diagnostic right and left heart catheterization. Hemodynamics were obtained at rest, after intravenous administration of 40 mg dipyridamole and after 5 mg isosorbide dinitrate sublingually. An increase in cardiac index and stroke volume index was noted, while left ventricular enddiastolic pressure and systemic vascular resistance decreased significantly. The twelve patients were then treated with 4 X 150 mg dipyridamole and 4 X 40 mg isosorbide dinitrate per day while also continuing the digitalis and diuretic treatment. They were followed up clinically for a period of 8 to 24 months. Three patients died but the other nine showed a clinical improvement (mean of 1.45 N.Y.H.A. classes). It was possible to perform a second right and left heart catheterization in four patients. Cardiac index, stroke volume index and maximum and minimum DP/dt were significantly higher, and left ventricular enddiastolic pressure was significantly lower, than before vasodilator therapy. These results suggest a sustained effect of dipyridamole and isosorbide dinitrate. The postextrasystolic modification of maximum DP/dt could be of prognostic value in congestive cardiomyopathy.(ABSTRACT TRUNCATED AT 250 WORDS)