Dilated cardiomyopathy natural history, complications and prognosis: Difference between revisions
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/* ACC/AHA/ESC 2006 Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death (DO NOT EDIT) {{cite journal| author=Zipes DP, Camm AJ, Borggrefe M, Buxton AE, Chaitman B, Fromer M et al.| title=AC... |
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| bgcolor="LightGreen"|<nowiki>"</nowiki> '''2.''' EP testing is useful for diagnostic evaluation in patients with nonischemic DCM with sustained palpitations, wide-QRS-complex tachycardia, presyncope, or syncope. ''([[ACC AHA Guidelines Classification Scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki> | | bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.''' EP testing is useful for diagnostic evaluation in patients with nonischemic DCM with sustained palpitations, wide-QRS-complex tachycardia, presyncope, or syncope. ''([[ACC AHA Guidelines Classification Scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki> | ||
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| bgcolor="LightGreen"|<nowiki>"</nowiki> '''3.''' An ICD should be implanted in patients with nonischemic DCM and significant LV dysfunction who have sustained VT or VF, are receiving chronic optimal medical therapy, and who have reasonable expectation of survival with a good functional status for more than 1 y. ''([[ACC AHA Guidelines Classification Scheme#Level of Evidence|Level of Evidence: A]])''<nowiki>"</nowiki> | | bgcolor="LightGreen"|<nowiki>"</nowiki>'''3.''' An ICD should be implanted in patients with nonischemic DCM and significant LV dysfunction who have sustained VT or VF, are receiving chronic optimal medical therapy, and who have reasonable expectation of survival with a good functional status for more than 1 y. ''([[ACC AHA Guidelines Classification Scheme#Level of Evidence|Level of Evidence: A]])''<nowiki>"</nowiki> | ||
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| bgcolor="LightGreen"|<nowiki>"</nowiki> '''4.''' ICD therapy is recommended for primary prevention to reduce total mortality by a reduction in SCD in patients with nonischemic DCM who have an LVEF less than or equal to 30% to 35%, are NYHA functional class II or III, who are receiving chronic optimal medical therapy, and who have reasonable expectation of survival with a good functional status for more than 1 y. ''([[ACC AHA Guidelines Classification Scheme#Level of Evidence|Level of Evidence: B]])'' (See Section 1.2.)<nowiki>"</nowiki> | | bgcolor="LightGreen"|<nowiki>"</nowiki>'''4.''' ICD therapy is recommended for primary prevention to reduce total mortality by a reduction in SCD in patients with nonischemic DCM who have an LVEF less than or equal to 30% to 35%, are NYHA functional class II or III, who are receiving chronic optimal medical therapy, and who have reasonable expectation of survival with a good functional status for more than 1 y. ''([[ACC AHA Guidelines Classification Scheme#Level of Evidence|Level of Evidence: B]])'' (See Section 1.2.)<nowiki>"</nowiki> | ||
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|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' ICD implantation can be beneficial for patients with unexplained syncope, significant LV dysfunction, and nonischemic DCM who are receiving chronic optimal medical therapy and who have reasonable expectation of survival with a good functional status for more than 1 y. ''([[ACC AHA Guidelines Classification Scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki> | |bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' ICD implantation can be beneficial for patients with unexplained syncope, significant LV dysfunction, and nonischemic DCM who are receiving chronic optimal medical therapy and who have reasonable expectation of survival with a good functional status for more than 1 y. ''([[ACC AHA Guidelines Classification Scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki> | ||
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|bgcolor="LemonChiffon"|<nowiki>"</nowiki> '''2.''' ICD implantation can be effective for termination of sustained VT in patients with normal or near normal ventricular function and nonischemic DCM who are receiving chronic optimal medical therapy and who have reasonable expectation of survival with a good functional status for more than 1 y. ''([[ACC AHA Guidelines Classification Scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki> | |bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.''' ICD implantation can be effective for termination of sustained VT in patients with normal or near normal ventricular function and nonischemic DCM who are receiving chronic optimal medical therapy and who have reasonable expectation of survival with a good functional status for more than 1 y. ''([[ACC AHA Guidelines Classification Scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki> | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
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Overview
Prognosis
There are many prognostic factors which can be evaluated in a patient with dilated cardiomyopathy.[1] The most important prognostic indicator is a decreased ejection fraction, in addition increased left ventricular size and right ventricular dilation are independent indicators of a poor prognosis.
As is in most types of heart failure a poor NYHA functional class and increased PASP (>35mmHg) are also poor prognostic indicators.
Other findings that infer a poor prognosis are as follows: Maximal O2 uptake of < 12mL/kg / minute on exercise testing, LBBB (left bundle branch block), non sustained ventricular tachycardia, syncope, hyponatremia with a serum sodium less than 135, elevated norepinephrine, ANP (atrial natriuretic peptide) and renin levels (not routinely measured in clinical practice), elevated PCWP (pulmonary capillary wedge pressure) > 18mmHg, low cardiac index < 2.5L/min/m^2.
ACC/AHA/ESC 2006 Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death (DO NOT EDIT) [2]
Recommendations for Dilated Cardiomyopathy (Nonischemic)
| Class I |
| "1. EP testing is useful to diagnose bundle-branch reentrant tachycardia and to guide ablation in patients with nonischemic DCM. (Level of Evidence: C)" |
| "2. EP testing is useful for diagnostic evaluation in patients with nonischemic DCM with sustained palpitations, wide-QRS-complex tachycardia, presyncope, or syncope. (Level of Evidence: C)" |
| "3. An ICD should be implanted in patients with nonischemic DCM and significant LV dysfunction who have sustained VT or VF, are receiving chronic optimal medical therapy, and who have reasonable expectation of survival with a good functional status for more than 1 y. (Level of Evidence: A)" |
| "4. ICD therapy is recommended for primary prevention to reduce total mortality by a reduction in SCD in patients with nonischemic DCM who have an LVEF less than or equal to 30% to 35%, are NYHA functional class II or III, who are receiving chronic optimal medical therapy, and who have reasonable expectation of survival with a good functional status for more than 1 y. (Level of Evidence: B) (See Section 1.2.)" |
| Class IIa |
| "1. ICD implantation can be beneficial for patients with unexplained syncope, significant LV dysfunction, and nonischemic DCM who are receiving chronic optimal medical therapy and who have reasonable expectation of survival with a good functional status for more than 1 y. (Level of Evidence: C)" |
| "2. ICD implantation can be effective for termination of sustained VT in patients with normal or near normal ventricular function and nonischemic DCM who are receiving chronic optimal medical therapy and who have reasonable expectation of survival with a good functional status for more than 1 y. (Level of Evidence: C)" |
References
- ↑ Mayo Clinic Cardiology. Concise Textbook. Murphy, Joseph G; Lloyd, Margaret A. Mayo Clinic Scientific Press. 2007.
- ↑ Zipes DP, Camm AJ, Borggrefe M, Buxton AE, Chaitman B, Fromer M; et al. (2006). "ACC/AHA/ESC 2006 Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: a report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (writing committee to develop Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death): developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society". Circulation. 114 (10): e385–484. doi:10.1161/CIRCULATIONAHA.106.178233. PMID 16935995.