Abstract:
:As the next millennium approaches, excitement and promise characterize the future of dilated cardiomyopathy. Until recently, dilated cardiomyopathy was considered an incurable, uniformly fatal chronic disease. Epidemiologic studies have demonstrated that at least a quarter of patients with recent onset of symptoms with cardiomyopathy manifest spontaneous improvement and a sustained favorable prognosis. It is imperative that patients who present with new-onset cardiomyopathy be managed medically and closely followed. Medical treatment remains the foundation of therapy, and certainly the advent of beta-blocker use may herald further benefit beyond that observed with conventional therapy (ACE inhibitors and digoxin). Unless mechanical support is required for hemodynamic instability and end organ failure, patients should be treated medically and observed. As discussed earlier, transient mechanical support as a bridge to recovery should be considered in the appropriate clinical scenario before committing to cardiac transplantation. Patients with established disease who have been followed for extended periods (> 6 months) that have progressive symptoms despite optimal medical therapy should be considered for surgical therapies. Cardiac transplantation is available to only a minority of the diseased population. All newer modalities of surgical unloading therapy theoretically reduce wall stress. Clearly in dilated cardiomyopathy, ventricular performance is reduced; however, individual myocyte contractile function may be intact. Studies of isolated myocytes (which are unloaded) have yielded conflicting data; however, if contractile function is intact and performance is reduced primarily secondary to abnormal loading conditions, surgical unloading therapies should yield benefit. Hence the thesis of Batista that geometric alteration will improve performance assumes intrinsic integrity of the myocyte contractile function. The implication of intrinsic myocyte contractile dysfunction is that surgical remodeling does not yield improved ventricular performance. Although clinicians have learned that selection criteria appear to play a role in predicting beneficial outcomes with cardiomyoplasty and the Batista procedure, clinical techniques to assess the integrity of myocyte function are unsophisticated. Quantifying interstitial fibrosis, assays for the degree of apoptosis, and various immunologic measures currently do not provide the insight necessary to predict outcomes reliably. The future assessment of dilated cardiomyopathy and the decision to consider alternative surgical procedures versus cardiac transplantation will likely be determined by biomolecular studies. At present, these new surgical procedures are promising therapies and potential alternatives to cardiac transplantation. Controlled studies to determine the clinical and survival benefit compared with medical therapy will ultimately be required, after the surgical techniques and patient selection criteria are refined. Randomized, prospective controlled studies assessing LVAD therapy and cardiomyoplasty are in progress.
journal_name
Cardiol Clinjournal_title
Cardiology clinicsauthors
Starling RC,Young JBdoi
10.1016/s0733-8651(05)70047-3subject
Has Abstractpub_date
1998-11-01 00:00:00pages
727-37issue
4eissn
0733-8651issn
1558-2264pii
S0733-8651(05)70047-3journal_volume
16pub_type
杂志文章,评审abstract::Syncope due to idiopathic AV block is characterized by: 1) ECG documentation (usually by means of prolonged ECG monitoring) of paroxysmal complete AV block with one or multiple consecutive pauses, without P-P cycle lengthening or PR interval prolongation, not triggered by atrial or ventricular premature beats nor by r...
journal_title:Cardiology clinics
pub_type: 杂志文章,评审
doi:10.1016/j.ccl.2015.04.012
更新日期:2015-08-01 00:00:00
abstract::The Fontan operation is a unique approach to create a circulation in series without 2 distinct pumping chambers. Although the approach has enabled many patients to live well into adulthood, the unique physiology results in many complications, cardiac and extracardiac. This review focuses on the pathophysiology of the ...
journal_title:Cardiology clinics
pub_type: 杂志文章,评审
doi:10.1016/j.ccl.2015.07.010
更新日期:2015-11-01 00:00:00
abstract::Proarrhythmia is a potentially lethal adverse effect of antiarrhythmic drugs. Underlying mechanisms and the approaches to identification are discussed. The applicability of electrophysiologic testing is considered, with particular reference to the validity of the different responses to programmed stimulation considere...
journal_title:Cardiology clinics
pub_type: 杂志文章,评审
doi:
更新日期:1986-08-01 00:00:00
abstract::One of the major drivers of change in the practice of cardiology is population change. This article discusses the current debate about epidemiologic transition paired with other ongoing transitions with direct relevance to cardiovascular conditions. Challenges specific to patterns of risk factors over time; readiness ...
journal_title:Cardiology clinics
pub_type: 杂志文章,评审
doi:10.1016/j.ccl.2016.08.004
更新日期:2017-02-01 00:00:00
abstract::Besides the anatomoclinical correlates of disturbances in impulse formation and conduction, this article also considers the three mechanisms now known to underlie tachyarrhythmias: focally enhanced automaticity, triggered activity, and, in particular, reentry. ...
journal_title:Cardiology clinics
pub_type: 杂志文章,评审
doi:
更新日期:1983-02-01 00:00:00
abstract::To whatever extent the improvement in symptoms and survival rendered by treatment with ACE inhibitors is attributable to their effects on the circulation and the kidneys, this benefit can be rescinded by concomitant administration of aspirin. Although some useful prostaglandin-independent actions may persist, shutting...
journal_title:Cardiology clinics
pub_type: 杂志文章,评审
doi:10.1016/s0733-8651(05)70246-0
更新日期:2001-11-01 00:00:00
abstract::The indications for clinical electrophysiologic study have continued to evolve since the introduction of this technique in the mid 1960s. They now include evaluation of sinus node dysfunction, AV conduction disturbances, syncope of unknown etiology, supraventricular arrhythmias with and without Wolff-Parkinson-White s...
journal_title:Cardiology clinics
pub_type: 杂志文章
doi:
更新日期:1985-02-01 00:00:00
abstract::The initial evaluation of patients with transient loss of consciousness (LOC) comprises a detailed medical history, physical examination, and 12-lead electrocardiogram. Because there are many causes of syncopal and nonsyncopal LOC, an adequate method of taking the clinical history, which is the cornerstone of diagnosi...
journal_title:Cardiology clinics
pub_type: 杂志文章,评审
doi:10.1016/j.ccl.2015.04.002
更新日期:2015-08-01 00:00:00
abstract::Targeted ultrasound imaging uses acoustically active contrast agents bearing a ligand on the surface that binds to a function-specific molecule. These ultrasound contrast agents are typically gas-filled microbubbles, nongaseous liposomes, or lipid-encapsulated perfluorocarbon emulsions. Binding of the contrast agent t...
journal_title:Cardiology clinics
pub_type: 杂志文章,评审
doi:10.1016/j.ccl.2004.02.008
更新日期:2004-05-01 00:00:00
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journal_title:Cardiology clinics
pub_type: 杂志文章,评审
doi:
更新日期:1986-02-01 00:00:00
abstract::Although it is convenient to think of hypertension in its renal, epidemiologic, and vascular eras, a new perspective is rapidly coming to the forefront. As we become more critical in evaluating the performance of our health care systems, it is obvious that the major problems in hypertension do not lie entirely with un...
journal_title:Cardiology clinics
pub_type: 杂志文章,评审
doi:
更新日期:1995-11-01 00:00:00
abstract::The electrocardiographic diagnosis of myocardial infarction (MI) in the presence of left bundle branch block (LBBB) has long been considered problematic or even almost impossible. Many proposed ECG markers in the old literature have now been discarded. However, the advent of reperfusion therapy has generated greater i...
journal_title:Cardiology clinics
pub_type: 杂志文章,评审
doi:10.1016/j.ccl.2006.05.002
更新日期:2006-08-01 00:00:00
abstract::Coronary artery bypass grafting (CAGB) is superior to percutaneous coronary intervention (PCI) in reducing mortality in certain patients and improving the composite end points of angina, recurrent myocardial infarction, and repeat revascularization procedures. However, CABG is associated with a higher perioperative st...
journal_title:Cardiology clinics
pub_type: 杂志文章,评审
doi:10.1016/j.ccl.2014.04.011
更新日期:2014-08-01 00:00:00
abstract::Ischemic heart disease remains the leading cause of death worldwide. Low-density lipoprotein cholesterol (LDL-C) has proved to have a causal relationship with atherosclerotic cardiovascular disease. Lowering LDL-C improves outcomes, although some patients continue to have residual risk of cardiovascular disease. Cardi...
journal_title:Cardiology clinics
pub_type: 杂志文章,评审
doi:10.1016/j.ccl.2017.12.002
更新日期:2018-05-01 00:00:00
abstract::There have been significant advances in the diagnosis and treatment of the patient with mitral stenosis over the past two decades. Two-dimensional and Doppler echocardiography have supplanted the cardiac catheterization laboratory in the diagnosis and determination of the hemodynamic severity of the stenotic mitral va...
journal_title:Cardiology clinics
pub_type: 杂志文章,评审
doi:10.1016/s0733-8651(05)70021-7
更新日期:1998-08-01 00:00:00
abstract::Transesophageal echocardiography has assisted the detection of intracardiac masses and, in certain cases, aided our ability to define the specific type of mass. This technique, when coupled with three-dimensional imaging, may help to define infiltration of the wall. TEE aids in the intraoperative management of cardiac...
journal_title:Cardiology clinics
pub_type: 杂志文章,评审
doi:10.1016/s0733-8651(05)70184-3
更新日期:2000-11-01 00:00:00
abstract::Mechanical circulatory assistance is making the transition from an investigational technique to standard clinical practice, especially for post-cardiotomy shock. History, techniques, medications, complications, and results of mechanical assistance are reviewed. Promising trends for the future are presented. ...
journal_title:Cardiology clinics
pub_type: 杂志文章,评审
doi:
更新日期:1988-08-01 00:00:00
abstract::The Swan-Ganz catheter was developed 35 to 40 years ago for intensive and cardiac care units to allow bedside placement and continuous monitoring and recording of right-sided heart, pulmonary artery, and wedge pressures and reasonably accurate determinations of cardiac output. Considerations for the clinical applicati...
journal_title:Cardiology clinics
pub_type: 历史文章,杂志文章,评审
doi:10.1016/j.ccl.2007.08.005
更新日期:2007-11-01 00:00:00
abstract::This article discusses the epidemiology of cardiovascular (CV) events in end-stage and early renal disease, summarizes the profile of classic and nonclassic CV risk factors in renal patients, highlights recent evidence documenting accelerated atherogenesis in renal disease, and provides information on the central arte...
journal_title:Cardiology clinics
pub_type: 杂志文章,评审
doi:10.1016/j.ccl.2005.03.002
更新日期:2005-08-01 00:00:00
abstract::Evaluation of mitral regurgitation (MR) severity remains complex and challenging. An integrative approach to grading MR is recommended. The use of multiple Doppler methods should be used to help discriminate between grades of severity. Importantly, MR severity should always be considered in the context of clinical dat...
journal_title:Cardiology clinics
pub_type: 杂志文章,评审
doi:10.1016/j.ccl.2013.04.002
更新日期:2013-05-01 00:00:00
abstract::Cardiac arrest in pregnancy is not only uncommon but also catastrophic. Early aggressive resuscitation by well-trained health care providers improves the chances of successful outcomes for both the patient and her fetus. Significant physiologic changes that occur normally in pregnancy require several modifications to ...
journal_title:Cardiology clinics
pub_type: 杂志文章,评审
doi:10.1016/j.ccl.2012.04.006
更新日期:2012-08-01 00:00:00
abstract::Percutaneous transvenous balloon mitral valvuloplasty is a well-established alternative to surgical commissurotomy for selected symptomatic patients with rheumatic mitral stenosis. This procedure normally is performed with fluoroscopic guidance; however, even the experienced operator can be misled by radiographic land...
journal_title:Cardiology clinics
pub_type: 杂志文章,评审
doi:
更新日期:1993-08-01 00:00:00
abstract::The majority of individuals with diabetes die from cardiovascular disease (CVD) and related complications. The risk of CVD is 2 to 4 fold greater in diabetes and largely magnified by co-morbidities that aggregate along with it. Sufficient evidence-based data now exist to support multifactorial risk intervention with s...
journal_title:Cardiology clinics
pub_type: 杂志文章,评审
doi:10.1016/j.ccl.2010.11.004
更新日期:2011-02-01 00:00:00
abstract::The development and use of antiretroviral medications to treat patients infected with human immunodeficiency virus (HIV) has dramatically changed the course of this disease from one that was fatal to a chronic and more manageable condition. Recommendations and guidelines for the general population are presented in thi...
journal_title:Cardiology clinics
pub_type: 杂志文章,评审
doi:10.1016/j.ccl.2015.01.003
更新日期:2015-05-01 00:00:00
abstract::This is an extensive review of thrombolysis in myocardial infarction with discussions of the pathophysiology of occlusion, clinical occlusion and rationale for thrombolysis, thrombolytic agents, results of thrombolysis (incidence of reperfusion, left ventricular function, and mortality), complications of thrombolytic ...
journal_title:Cardiology clinics
pub_type: 杂志文章,评审
doi:
更新日期:1988-02-01 00:00:00
abstract::On a variety of fronts, chronic infection has been found to be significantly associated with the development of atherosclerosis and the clinical complications of unstable angina, myocardial infarction, and stroke. For the most part, these relationships are still just associations. Failure to confirm initial reports of...
journal_title:Cardiology clinics
pub_type: 杂志文章,评审
doi:10.1016/s0733-8651(03)00054-7
更新日期:2003-08-01 00:00:00
abstract::Stress-first approaches to myocardial perfusion imaging provide diagnostically and prognostically accurate perfusion data equivalent to a full rest-stress study, save time in the imaging laboratory, and reduce the radiation exposure to patients and laboratory staff. Converting a nuclear cardiology laboratory from a co...
journal_title:Cardiology clinics
pub_type: 杂志文章,评审
doi:10.1016/j.ccl.2015.06.006
更新日期:2016-02-01 00:00:00
abstract::The overall management and prognosis of patients with acute myocardial infarction must take into account not only infarct size but also the site and locus of involvement as determined by electrocardiography. Transmural versus nontransmural infarction is discussed in relation to therapy and prognosis. ...
journal_title:Cardiology clinics
pub_type: 杂志文章,评审
doi:
更新日期:1984-02-01 00:00:00
abstract::Exercise training can have a profound effect on cardiac structure. Recent evidence suggests that the greatest determinants of exercise-induced cardiac remodeling are the intensity, duration, and frequency of training. This also has overlap with athlete fitness. There are many additional factors that are important in d...
journal_title:Cardiology clinics
pub_type: 杂志文章,评审
doi:10.1016/j.ccl.2016.06.001
更新日期:2016-11-01 00:00:00
abstract::Incident heart failure and the burden of hospitalization may be demonstrating a decline. However, as the population ages, the prevalence of heart failure continues to increase. Mortality among heart failure patients is increasingly due to non-cardiovascular causes. Current evidence-based therapy for heart failure has ...
journal_title:Cardiology clinics
pub_type: 杂志文章,评审
doi:10.1016/j.ccl.2016.12.008
更新日期:2017-05-01 00:00:00