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Cardiomyopathy patients find hope with drug therapy: a regimen of beta blockers and ACE inhibitors can strengthen heart function and reduce an enlarged heart in many cases.

The causes of cardiomyopathy, a disease of the heart muscle that results in reduced pumping ability, often can be difficult to determine. But new research shows that a combination of beta blockers and angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) may be the answer for many patients.


The study

Cleveland Clinic cardiologist Randall Starling, MD, MPH, last fall presented preliminary results of a study of 260 patients with acute idiopathic (from an unknown cause) cardiomyopathy. The patients were put on a standard regimen of beta blockers and ACE inhibitors or ARBs, under guidelines determined by the American Heart Association (AHA) and the American College of Cardiology. The study showed that a healthy left ventricular ejection fraction--the percentage of blood pumped from the ventricle with each heartbeat--was achieved within six months for about one half of the participants.

According to Dr. Starling, not long ago, the best chance for recovery for a patient with cardiomyopathy and an ejection fraction of 20 percent, for example, was a heart transplant. "Now, when we see a patient like that, we're encouraged that they have a very good chance of recovery with standard therapy," he says.

Recognizing cardiomyopathy

Cardiomyopathy affects more than 50,000 Americans and is more common among older men. If left untreated, it can worsen quickly. Symptoms can include shortness of breath, swelling in the legs, palpitations, dizziness, and chest pain.

Tests to diagnose the disease include an echocardiogram, computed tomography (CT) and magnetic resonance imaging (MRI) scans of the chest, and electrocardiogram.

The most common form of the condition is dilated cardiomyopathy, characterized by an enlargement of the left ventricle and a poor ejection fraction. Those symptoms also can be related to valve problems and other forms of heart disease, but if those causes are ruled out, cardiologists are often left diagnosing the patient as having idiopathic dilated cardiomyopathy, Dr. Starling says.

Promising research

Among the 260 patients in Dr. Starling's study, 53 percent recovered an ejection fraction of at least 40 percent. Nearly 20 percent of the patients saw their ejection fraction improve to better than 50 percent. Others saw little or no improvement. The study was presented at the American Heart Association's annual Scientific Sessions in November.

The combination of beta blockers and ACE inhibitors or ARBs also helped reverse the enlargement of the heart, which is critical to long-term survival. Dr. Starling notes that if cardiomyopathy is diagnosed early, before the heart becomes too enlarged, a patient may be able to undo most of the damage.

"Smaller hearts have the best odds of recovery," Dr. Starling says. "If the heart is not too enlarged, we think there's about a 40 to 50 percent chance of marked improvement."

But Dr. Starling adds that even if the heart size improves, along with the ejection fraction, patients should expect to remain on their medications for the rest of their lives to avoid setbacks.

Dr. Starling says the next phase of research will look at long-term survival, as well as seek out biomarkers and genetic profiles that may predispose people to cardiomyopathy.


Cardiomyopathy appears in several forms, including:

* Ischemic: Caused by heart attacks that scar the heart muscle.

* Hypertensive: Results from long-term, often untreated high blood pressure.

* Infectious: Linked to HIV, Lyme disease, viral myocarditis, and other infections.

* Alcoholic: Usually begins about 10 years after sustained, heavy alcohol consumption and is often accompanied by a heart rhythm disorder.

* Tachycardia mediated: Occurs in people with abnormally fast heart rates.

* Hypertrophic: Thickened heart muscle with reduced blood flow and impaired ejection.
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Title Annotation:BREAKTHROUGHS; angiotensin-converting enzyme
Publication:Heart Advisor
Geographic Code:1USA
Date:Mar 1, 2008
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