Sadamasa Ogasawara

Prognosis of dilated cardiomyopathy: An integrated analysis including endomyocardial biopsy findings

SummaryA long-term prognostic study of up to 15 years of dilated cardiomyopathy (DCM) was carried out in 65 cases. The 5-year survival rate after the onset of subjective symptoms was 40%, and the 10-year survival rate 22%. To evaluate the prognostic factor of DCM, the cardiothoracic ratio (CTR), ECG, hemodynamics, and histopathological contractility failure index (HCFI), which we constructed through right ventricular endomyocardial biopsy, were compared. Patients having malignant arrhythmias, such as short runs or multifocal ventricular premature beats with mild impaired cardiac status, mild cardiomegaly, and low HCFI, were more prone to sudden death. In patients with progressively deteriorating cardiac status, refractory cardiomegaly, supraventricular arrhythmias, left axis deviation, prolongation of QRS interval, low voltage, and high HCFI, the cause of death is more likely to be refractory heart failure.

Hemodynamic studies and response to a combined therapy of nitroglycerin ointment and dopamine in patients with acute myocarditis

SummaryLeft ventricular performance was assessed in ten patients with acute myocarditis during the acute stage (within the first 3 days after the onset of cardiac symptoms) and during the convalescent phase (3–5 weeks later). In nine, the diagnosis was confirmed by endomyocardial biopsy during the acute stage, when left ventricular function was markedly reduced, i.e., cardiac index 1.53±0.33 1/min/m2 (mean ±SD), left ventricular stroke work index 14.1±3.9 g/beat/m2, pulmonary capillary pressure 25.9±4.3 mm Hg, and systemic vascular resistance 27.9±9.4 R units. During convalescence, seven patients improved clinically with normal cardiac function and in three it remained impaired. Cardiovascular response to nitroglycerin ointment in three patients and a combination of dopamine and nitroglycerin ointment in five were compared. Nitroglycerin ointment reduced pulmonary capillary pressure by an average of 28.5% (P<0.05) and systemic vascular resistance by 26.8%, while the cardiac index increased by 34.1% (P<0.05) and left ventricular stroke work index by 30.3% (P<0.01). The combined therapy was more effective, with a reduction of pulmonary capillary pressure by 30.4% (P<0.05) and systemic vascular resistance by 27.5% (P<0.05), accompanying an increase in cardiac index by 53.5% (P<0.005) and left ventricular stroke work index by 63.5% (P<0.01), with little change in the double products. This study suggests that serial hemodynamic monitoring accurately evaluates cardiac function, selection of appropriate therapy, and the hemodynamic effects of treatment in patients with acute myocarditis. In particular, the combination therapy has beneficial advantages without causing a significant change in the myocardial oxygen consumption.