PMID- 10410811
OWN - NLM
STAT- MEDLINE
DCOM- 19990803
LR  - 20090213
IS  - 0003-9683 (Print)
IS  - 0003-9683 (Linking)
VI  - 92
IP  - 6
DP  - 1999 Jun
TI  - [Treatment of cardiac insufficiency: does treatment depend on whether its cause 
      is ischemic or idiopathic?].
PG  - 727-32
AB  - Angiotensin converting enzyme (ACE) inhibitors are associated with a greater 
      reduction in mortality in non-ischaemic cardiomyopathy than in ischaemic 
      cardiomyopathy after the results of the V-HeFT-II and SOLVD trials in symptomatic 
      patients. However, a recent analysis of the global, symptomatic and therapeutic, 
      results of the SOLVD trials, demonstrated a similar reduction in mortality with 
      ACE inhibitors in ischaemic and non-ischaemic cardiomyopathies. Moreover, after 
      myocardial infarction, the beneficial effects of ACE inhibitors have been well 
      established in patients with left ventricular dysfunction. Betablockers, 
      especially bisoprolol in the CIBIS-I trial, also seem to be more effective in 
      non-ischaemic cardiomyopathy. However, CIBIS-II and the US Carvedilol Heart 
      Failure Trial Program clearly showed that the benefits of betablockade were 
      identical whether ischaemic or not. The beneficial effects of betablockers in the 
      post-infarction period are more marked when left ventricular dysfunction is 
      severe. The PROVED and RADIANCE trials suggest that digitalis is more effective 
      in non-ischaemic cardiomyopathy. These results were not confirmed by the DIG 
      trial which showed a significant reduction in the combined criterion, mortality 
      and hospital admission for aggravation of cardiac failure, both in ischaemic and 
      in non-ischaemic cardiomyopathy. However, the use of digitalis should be prudent 
      during ischaemic cardiomyopathy, the neutral effect on global mortality in the 
      DIG trial masking divergent results with a tendency to reducing mortality due to 
      aggravation of cardiac failure and a significant increase of other causes of 
      cardiac death, especially from myocardial infarction and arrhythmias. Amiodarone 
      could also be useful in non-ischaemic cardiomyopathy. The reduction in risk of 
      death in the GESICA study, which comprised 60% of patients with non-ischaemic 
      cardiomyopathy, contrasting with the absence of an effect with this molecule in 
      the STAT-CHF trial which only comprised 29% of patients with non-ischaemic 
      cardiomyopathy. The new generation of calcium antagonists could also be more 
      effective in non-ischaemic cardiomyopathy. Although amlodipine significantly 
      reduced mortality in the PRAISE trial in non-ischaemic cardiomyopathy, there was 
      no favourable effect with felodipine in the V-HeFT-III tria. Finally, if in the 
      earlier studies oral anticoagulants were more effective in non-ischaemic 
      cardiomyopathy, the recent results of the SOLVD trial showed that warfarin 
      decreased the mortality in both ischaemic and non-ischaemic cardiomyopathy. The 
      value of anti-aggregant therapy is not questioned in coronary artery disease, but 
      its role in dilated cardiomyopathy has not yet been established. In conclusion, 
      apart from the use of digitalis which must be prudent in post-infarction 
      cardiomyopathy or in patients with ventricular arrhythmias, the treatment of 
      cardiac failure differs little with respect to its ischaemic or non-ischaemic 
      aetiology, and should be based on the NYHA (New York Heart Association) 
      classification.
FAU - Galinier, M
AU  - Galinier M
AD  - Service de cardiologie clinique et experimentale, Centre hospitalo-universitaire 
      de Toulouse Rangueil.
FAU - Bounhoure, J P
AU  - Bounhoure JP
LA  - fre
PT  - English Abstract
PT  - Journal Article
TT  - Le traitement de l'insuffisance cardiaque est-il different selon sa cause, 
      ischemique ou idiopathique?
PL  - France
TA  - Arch Mal Coeur Vaiss
JT  - Archives des maladies du coeur et des vaisseaux
JID - 0406011
SB  - IM
MH  - Cardiomyopathy, Dilated/*complications
MH  - Heart Failure/*etiology/therapy
MH  - Humans
MH  - Myocardial Ischemia/*complications
EDAT- 1999/07/20 00:00
MHDA- 1999/07/20 00:01
CRDT- 1999/07/20 00:00
PHST- 1999/07/20 00:00 [pubmed]
PHST- 1999/07/20 00:01 [medline]
PHST- 1999/07/20 00:00 [entrez]
PST - ppublish
SO  - Arch Mal Coeur Vaiss. 1999 Jun;92(6):727-32.