digitoxin and Death--Sudden--Cardiac

Outcome is better in patients with idiopathic dilated cardiomyopathy (IDC) than in ischemic heart failure (HF), but morbidity and mortality are nevertheless presumed to be substantial. Most data on the prognosis in IDC stem from research performed before the widespread use of current evidence-based treatment, including implantable devices. We report outcome data from a cohort of patients with IDC treated according to current HF guidelines and compare our results with previous figures: 102 consecutive patients referred to our tertiary care hospital with idiopathic IDC and a left ventricular ejection fraction <40% were included in a prospective cohort study. After extensive baseline work-up, follow-up was performed after 6 and 13 months. Vital status and heart transplantation were recorded. Over the first year of follow-up, the patients were on optimal pharmacological treatment, and 24 patients received implantable devices. Left ventricular ejection fraction increased from 26 ± 10% to 41 ± 11%, peak oxygen consumption increased from 19.5 ± 7.1 to 23.4 ± 7.8 ml/kg/min, and functional class improved substantially (all p values <0.001). After a median follow-up of 3.6 years, 4 patients were dead, and heart transplantation had been performed in 9 patients. According to our literature search, survival in patients with IDC has improved substantially over the last decades. In conclusion, patients with IDC have a better outcome than previously reported when treated according to current guidelines.

Topics: Adrenergic beta-Antagonists; Adult; Aged; Angiotensin Receptor Antagonists; Angiotensin-Converting Enzyme Inhibitors; Cardiac Resynchronization Therapy; Cardiomyopathy, Dilated; Cardiotonic Agents; Cohort Studies; Death, Sudden, Cardiac; Defibrillators, Implantable; Digitoxin; Digoxin; Diuretics; Exercise Test; Female; Heart Transplantation; Humans; Male; Middle Aged; Mineralocorticoid Receptor Antagonists; Oxygen Consumption; Prospective Studies; Stroke Volume; Treatment Outcome; Ventricular Dysfunction, Left

To study the risk factors for cardiac mortality after coronary artery bypass graft surgery.. Follow up study of patients who had undergone coronary artery bypass graft surgery at the University Hospital of Oulu, Finland.. 339 consecutive patients who underwent cardiac catheterisation three months after bypass surgery.. Incidence of cardiac deaths during the follow up period of five years and predictive value of clinical and angiographic variables for subsequent cardiac mortality.. The incidence of cardiac deaths was 5.1%, and 81% of these were sudden deaths. The postoperative ejection fraction was significantly lower in the patients with subsequent cardiac death than in the survivors (p less than 0.001), and their left ventricular end systolic and end diastolic volumes were higher (p less than 0.001 and p less than 0.05 respectively). The incidence of cardiac deaths was 43% in the patients with a postoperative ejection fraction of less than 40%. The myocardial jeopardy index after surgery and the rate of graft patency were not significantly different in the survivors and patients who died. The only clinical factors that were different between the groups were postoperative use of diuretics (p less than 0.001) or digitalis (p = 0.02). After adjustment for other prognostic variables by the proportional hazards method, a low postoperative ejection fraction remained significant as a predictor of the relative risk of cardiac mortality five years after operation (p less than 0.01).. Patients with angiographic evidence of impaired left ventricular function after bypass surgery are still at relatively high risk of dying suddenly, but myocardial ischaemia due to incomplete revascularisation is not strongly associated with an increased risk of cardiac mortality. Conventional clinical methods do not seem to be helpful for identifying patients with an increased risk of cardiac death after bypass surgery.

Topics: Cardiac Catheterization; Coronary Angiography; Coronary Artery Bypass; Death, Sudden, Cardiac; Digitalis; Diuretics; Female; Follow-Up Studies; Humans; Incidence; Male; Middle Aged; Plants, Medicinal; Plants, Toxic; Postoperative Period; Predictive Value of Tests; Preoperative Care; Prognosis; Prospective Studies; Risk Factors; Stroke Volume; Survival Rate