Back to Search
Start Over
Effect of preload reducing therapy on right ventricular size and function in patients with arrhythmogenic right ventricular cardiomyopathy.
Effect of preload reducing therapy on right ventricular size and function in patients with arrhythmogenic right ventricular cardiomyopathy.
- Source :
-
Heart rhythm [Heart Rhythm] 2021 Jul; Vol. 18 (7), pp. 1186-1191. Date of Electronic Publication: 2021 Mar 17. - Publication Year :
- 2021
-
Abstract
- Background: Arrhythmogenic right ventricular cardiomyopathy (ARVC) is an important cause of sudden cardiac death in young people and athletes. To date, no treatment has proven to slow the progression of the disease. Preload reducing agents such as nitrates and diuretics have shown promising results in preventing training-induced development of ARVC in a murine model.<br />Objective: The purpose of this study was to describe our experience with preload reducing therapy in patients with ARVC and symptomatic right ventricular (RV) dysfunction.<br />Methods: We performed retrospective chart review of prospectively collected registry data and included 20 patients with definite ARVC who had serial echocardiographic measurements and an implantable cardioverter-defibrillator. Six of the 20 patients with RV end-diastolic area (RVEDA) above median (>25 cm <superscript>2</superscript> ) and New York Heart Association functional class II-IV symptoms were successfully treated with long-term isosorbide dinitrate 5-40 mg tid (at maximum tolerated dose) and hydrochlorothiazide-spironolactone 25-25 mg daily. The main outcomes of interest were RVEDA, RV fractional area change (FAC), and RV outflow tract measurements. Generalized estimating equations with repeated measures were used to identify the association between preload reducing agents and echocardiographic structural progression.<br />Results: Patients who received preload reducing agents (n = 6) were older and had larger RVs with lower FAC at baseline. However, treatment with preload reducing agents was associated with less RVEDA enlargement during mean 3.3 (range 1-6.7) years of treatment in multivariate analysis (% change in RVEDA associated with treatment -7.71; 95% confidence interval -13.29 to -2.13; P = .007).<br />Conclusion: Preload reducing agents show promising results in slowing RV enlargement in patients with ARVC and show possible disease-modifying potential.<br /> (Copyright © 2021 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.)
- Subjects :
- Adult
Arrhythmogenic Right Ventricular Dysplasia diagnosis
Arrhythmogenic Right Ventricular Dysplasia physiopathology
Dose-Response Relationship, Drug
Drug Combinations
Female
Follow-Up Studies
Heart Ventricles physiopathology
Humans
Male
Middle Aged
Organ Size
Retrospective Studies
Stroke Volume physiology
Time Factors
Vasodilator Agents administration & dosage
Ventricular Function, Right physiology
Arrhythmogenic Right Ventricular Dysplasia drug therapy
Echocardiography, Doppler methods
Heart Ventricles diagnostic imaging
Hydrochlorothiazide administration & dosage
Isosorbide Dinitrate administration & dosage
Spironolactone administration & dosage
Stroke Volume drug effects
Ventricular Function, Right drug effects
Subjects
Details
- Language :
- English
- ISSN :
- 1556-3871
- Volume :
- 18
- Issue :
- 7
- Database :
- MEDLINE
- Journal :
- Heart rhythm
- Publication Type :
- Academic Journal
- Accession number :
- 33722762
- Full Text :
- https://doi.org/10.1016/j.hrthm.2021.03.018