[Beneficial long-term effects of diltiazem on the course of dilated cardiomyopathy].
There is increasing evidence that chronic enhanced exogenic or endogenic catecholamine stimulation in patients with dilated cardiomyopathy may worsen hemodynamics and prognosis. The cause of this may lie in myocellular calcium accumulation and microcirculatory disorders. In a prospective study the calcium antagonist diltiazem was given to 22 patients with dilated cardiomyopathy (60-90 mg t.i.d.) in addition to conventional therapy of digitalis, diuretics, and vasodilators. Twenty-five patients received the conventional therapy and served as historical controls. Eight additional patients who were not originally included in the 25 controls changed over from conventional therapy to adjunctive diltiazem treatment. The patient groups compared were similar in all hemodynamic and anamnestic features. Further, only patients with reduced myofibril volume fraction in the myocardial biopsy were included in the trial, since hemodynamic deterioration could be expected in them. The mean survival rate was 29 months in the controls, while within a mean of 15.4 months no patient died in the diltiazem group (p less than 0.001). Mean left ventricular ejection fraction increased from 0.34 to 0.44 (p less than 0.001) and the New York Heart Association classification was significantly improved in the diltiazem group and during the diltiazem period in the crossovers, but deteriorated in the controls. Therefore, the results suggest that adjunctive diltiazem treatment in dilated cardiomyopathy has beneficial effects on letality, hemodynamics, and symptoms.
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Medizinische Universitätskliniken, Abteilung für Kardiologie und Pulmonologie, Göttingen.
von Rechenberg
J
J
Wiegand
V
V
Soballa
R
R
Kreuzer
H
H
D000328:Adult; D002302:Cardiac Output / Q000187:drug effects; D002311:Cardiomyopathy, Dilated / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D004110:Diltiazem / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008134:Long-Term Care; D008297:Male; D008854:Microscopy, Electron; D008875:Middle Aged; D009206:Myocardium / Q000473:pathology; D010865:Pilot Projects; D011446:Prospective Studies; D015996:Survival Rate
D004110:Diltiazem
Günstige Langzeitwirkungen von Diltiazem auf den Verlauf der dilatativen Kardiomyopathie.