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Multicenter study of the efficacy and safety of disopyramide in obstructive hypertrophic cardiomyopathy.
- Source :
-
Journal of the American College of Cardiology [J Am Coll Cardiol] 2005 Apr 19; Vol. 45 (8), pp. 1251-8. - Publication Year :
- 2005
-
Abstract
- Objectives: In this study we assessed the long-term efficacy and safety of disopyramide for patients with obstructive hypertrophic cardiomyopathy (HCM).<br />Background: It has been reported that disopyramide may reduce left ventricular outflow gradient and improve symptoms in patients with HCM. However, long-term efficacy and safety of disopyramide has not been shown in a large cohort.<br />Methods: Clinical and echocardiographic data were evaluated in 118 obstructive HCM patients treated with disopyramide at 4 HCM treatment centers. Mortality in the disopyramide-treated patients was compared with 373 obstructive HCM patients not treated with disopyramide.<br />Results: Patients were followed with disopyramide for 3.1 +/- 2.6 years; dose 432 +/- 181 mg/day (97% also received beta-blockers). Seventy-eight patients (66%) were maintained with disopyramide without the necessity for major non-pharmacologic intervention with surgical myectomy, alcohol ablation, or pacing; outflow gradient at rest decreased from 75 +/- 33 to 40 +/- 32 mm Hg (p < 0.0001) and mean New York Heart Association functional class from 2.3 +/- 0.7 to 1.7 +/- 0.6 (p < 0.0001). Forty other patients (34%) could not be satisfactorily managed with disopyramide and required major invasive interventions because of inadequate symptom and gradient control or vagolytic side effects. All-cause annual cardiac death rate between disopyramide and non-disopyramide-treated patients did not differ significantly, 1.4% versus 2.6%/year (p = 0.07). There was also no difference in sudden death rate, 1.0%/year versus 1.8%/year (p = 0.08).<br />Conclusions: Two-thirds of obstructed HCM patients treated with disopyramide could be managed medically with amelioration of symptoms and about 50% reduction in subaortic gradient over >/=3 years. Disopyramide therapy does not appear to be proarrhythmic in HCM and should be considered before proceeding to surgical myectomy or alternate strategies.
- Subjects :
- Administration, Oral
Adrenergic beta-Antagonists therapeutic use
Anti-Arrhythmia Agents administration & dosage
Cardiomyopathy, Hypertrophic mortality
Cardiomyopathy, Hypertrophic physiopathology
Death, Sudden, Cardiac
Disopyramide administration & dosage
Echocardiography
Female
Humans
Male
Middle Aged
Myocardial Contraction drug effects
Safety
Treatment Outcome
Anti-Arrhythmia Agents therapeutic use
Cardiomyopathy, Hypertrophic drug therapy
Disopyramide therapeutic use
Subjects
Details
- Language :
- English
- ISSN :
- 0735-1097
- Volume :
- 45
- Issue :
- 8
- Database :
- MEDLINE
- Journal :
- Journal of the American College of Cardiology
- Publication Type :
- Academic Journal
- Accession number :
- 15837258
- Full Text :
- https://doi.org/10.1016/j.jacc.2005.01.012