Long-term vasodilator therapy for heart failure: noninvasive evaluation and noninvasive predictors of survival

In eighteen consecutive patients (14 male, 4 females, in the age 37-52 years, mean = 43 years) with dilated cardiomyopathy in NYHA functional classification groups III-IV, the efficacy of ambulatory long-term (mean = 6 years) vasodilator therapy by means mechanocardiography (systolic and diastolic time intervals) and echocardiography (1-D, 2-D) in half-year intervals was evaluated. A combination of slow-release nitroglycerin (Nitro-Mack retard) as venodilator in the dosage of 20 mg/day and Dihydralazin SPOFA as arteriodilator in dosage of 100-200 mg/day under continuing cardiotonic and diuretic treatment were used. Vasodilator therapy had a favourable effect on systolic and diastolic function of the left ventricle with the mostly marked effect at the beginning of treatment. Amidst noninvasive parameters, the diastolic amplitude time index measured by apexcardiography and left ventricular hypertrophy-dilation index obtained by echocardiography had the greatest prognostic value regarding the treatment efficacy and survival of patients. This objective evidence of the efficacy of vasodilator therapy in patients with severe congestive heart failure coincided with the improvement of clinical status (subjective relief, moderation of decompensation, shift to the lower NYHA functional classes) and thus with improvement of life quality and prognosis.