SURGICAL THERAPY FOR DILATED CARDIOMYOPATHY - 09/09/11
Résumé |
Heart failure is a widespread epidemic and one of the most important public health problems in cardiovascular medicine, affecting approximately 2 to 4 million Americans.17, 20 Although mortality rates are declining in the United States secondary to coronary artery disease and stroke, hospitalizations for heart failure have increased substantially.21 In 1990, there were more than 700,000 hospital discharges with heart failure as the primary diagnosis21; This represents a fourfold increase since 1971. In 1990, there were 708,000 new heart failure patients and 280,000 deaths, which represent a net increase of 428,000 patients or 12% growth per year.35 It is estimated that about one half of the patients are 65 years of age or older. Reasons for this are multifactorial, but clearly the prevalence of heart failure increases with age, and this is a demographic reality in the United States. The advent of thrombolytic therapy, percutaneous coronary angioplasty, coronary artery bypass surgery, angiotensin-converting enzyme (ACE) inhibitors, hydroxymethylglutaryl-coenzyme A (HMG-CoA) reductase inhibitors (statins), and improved coronary care for acute myocardial infarction have reduced the mortality rate from coronary artery disease. Improved medical therapy for heart failure and medical and surgical treatment for arrhythmias in dilated cardiomyopathy patients have reduced short-term (1- to 5-year) mortality rates. Consequently, however, successful treatment strategies have resulted in an increasing pool of patients with left ventricular dysfunction and congestive heart failure.
Heart transplantation is the only treatment known to make a significant impact on the dismal 1- and 5-year mortality for patients with New York Heart Association (NYHA) class IV heart failure. Ten percent to 15% of patients with heart failure have advanced symptoms (NYHA class IV) and the highest 6- to 12-month mortality rate. Only about 2500 heart transplants are performed annually in the United States, and it is estimated between 45,000 and 70,000 patients per year are in need of this life-saving therapy. Until recently, no treatments other than cardiac transplantation were available. Justified by the inordinate demand versus supply, there is a tremendous impetus to develop new therapies for advanced heart failure.
It has now been established that heart failure is not an inexorably progressive disease. Often the heart failure syndrome can be effectively treated, and some forms of left ventricular dysfunction are reversible (e.g., hibernating myocardium, acute dilated cardiomyopathy, thyroid heart disease). Advances in medical therapy, including the use of β-blocker therapy, have demonstrated the ability to improve the biomechanical function and biomolecular perturbations of the chronically failing heart.12 Thus, when heart failure is present, it requires recognition, definition of its cause and treatment options, implementation of therapy, and assessment and follow-up of treatment efficacy.
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| Address reprint requests to Randall C. Starling, MD, MPH, Department of Cardiology, Desk F25, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, e-mail: STARLIR@cesmtp.ccf.org |
Vol 16 - N° 4
P. 727-737 - novembre 1998 Retour au numéro
Article précédent
- MEDICAL THERAPY OF CHRONIC HEART FAILURE : Role of ACE Inhibitors and β-Blockers
- Eric J. Eichhorn
- CELL CYCLE CONTROL IN THE TERMINALLY DIFFERENTIATED MYOCYTE : A Platform for Myocardial Repair?
- R. Sanders Williams
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