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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.

Authors :
Kalantarian S
Vittinghoff E
Klein L
Scheinman MM
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.)

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