PMID- 16996844
OWN - NLM
STAT- MEDLINE
DCOM- 20061018
LR  - 20161124
IS  - 1097-6744 (Electronic)
IS  - 0002-8703 (Linking)
VI  - 152
IP  - 4
DP  - 2006 Oct
TI  - Adjunctive therapy with low-molecular-weight heparin in patients with chronic 
      heart failure secondary to dilated cardiomyopathy: one-year follow-up results of 
      the randomized trial.
PG  - 713.e1-7
AB  - BACKGROUND: Defective endothelial function has been shown in dilated 
      cardiomyopathy. Therefore, improvement in endothelial function after 
      low-molecular-weight heparin (LMWH) therapy may be clinically beneficial. 
      Consequently, the effect of adjunct enoxaparin, a LMWH, on standard treatment of 
      dilated cardiomyopathy was investigated. METHODS: This was a randomized, standard 
      treatment-controlled, 2-center pilot trial of 102 patients (52 receiving 
      adjunctive therapy with enoxaparin at a dosage of 1.5 mg/kg daily for 3 months 
      and 50 receiving standard therapy with angiotensin-converting enzyme inhibitors, 
      beta-blockers, and diuretics alone) with stable chronic heart failure secondary 
      to dilated cardiomyopathy (New York Heart Association [NYHA] class II and III; 
      left ventricular [LV] ejection fraction, < or = 40%). All patients underwent 
      coronary angiography and endomyocardial biopsy and were clinically stable for at 
      least 6 months before enrollment. The combined primary end point included 
      mortality, urgent heart transplantation, and readmission to hospital due to heart 
      failure progression. The secondary end point was to determine the severity of 
      heart failure (serum level of N-terminal brain natriuretic peptide), cardiac 
      function (LV ejection fraction by radionuclide ventriculography), LV diameters by 
      echocardiography, exercise capacity (changes in NYHA class, changes in peak 
      oxygen consumption), and changes in quality of life (Minnesota Living with Heart 
      Failure questionnaire). The clinical outcome was assessed after 6 and 12 months 
      of therapy. RESULTS: Baseline characteristics were comparable in both groups. 
      Five patients dropped out during 12 months of the study. Twelve patients achieved 
      primary end point (8 in the control group and 4 in the LMWH group). The free 
      survival rate was 94% for the LMWH group and 90% for the controls (not 
      statistically significant). After the 12-month period, in the LMWH group, 
      N-terminal brain natriuretic peptide level and LV diameters decreased 
      significantly (P < .001 and P = .006, respectively), whereas LV systolic function 
      increased (P < .001). Changes in exercise capacity and subjective improvement did 
      not differentiate the groups (nonsignificant). Adverse reactions to the 
      enoxaparin therapy were minor and transient. CONCLUSIONS: In patients with 
      chronic heart failure due to dilated cardiomyopathy, adjunct long-term enoxaparin 
      therapy may offer additional clinical benefit without deleterious effects on 
      major cardiac events.
FAU - Wojnicz, Romuald
AU  - Wojnicz R
AD  - 3rd Department of Cardiology, Silesian Center of Heart Disease, Silesian Medical 
      University, Zabrze, Poland. wojnicz@dom.zabrze.pl
FAU - Nowak, Jolanta
AU  - Nowak J
FAU - Szygula-Jurkiewicz, Bozena
AU  - Szygula-Jurkiewicz B
FAU - Wilczek, Krzysztof
AU  - Wilczek K
FAU - Lekston, Andrzej
AU  - Lekston A
FAU - Trzeciak, Przemyslaw
AU  - Trzeciak P
FAU - Nowalany-Kozielska, Ewa
AU  - Nowalany-Kozielska E
FAU - Zembala, Marian
AU  - Zembala M
FAU - Wodniecki, Jan
AU  - Wodniecki J
FAU - Polonski, Lech
AU  - Polonski L
LA  - eng
PT  - Journal Article
PT  - Multicenter Study
PT  - Randomized Controlled Trial
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - Am Heart J
JT  - American heart journal
JID - 0370465
RN  - 0 (Anticoagulants)
RN  - 0 (Cardiovascular Agents)
RN  - 0 (Enoxaparin)
RN  - 0 (Peptide Fragments)
RN  - 0 (pro-brain natriuretic peptide (1-76))
RN  - 114471-18-0 (Natriuretic Peptide, Brain)
SB  - IM
MH  - Adult
MH  - Anticoagulants/administration & dosage/adverse effects/*therapeutic use
MH  - Cardiac Output, Low/diagnostic imaging/*drug therapy/*etiology/physiopathology
MH  - Cardiomyopathy, Dilated/*complications
MH  - Cardiovascular Agents/therapeutic use
MH  - Chronic Disease
MH  - Drug Administration Schedule
MH  - Drug Therapy, Combination
MH  - Echocardiography
MH  - Enoxaparin/administration & dosage/adverse effects/*therapeutic use
MH  - Female
MH  - Follow-Up Studies
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Natriuretic Peptide, Brain/blood
MH  - Peptide Fragments/blood
MH  - Pilot Projects
MH  - Survival Analysis
MH  - Systole
MH  - Treatment Outcome
MH  - Ventricular Function, Left
EDAT- 2006/09/26 09:00
MHDA- 2006/10/19 09:00
CRDT- 2006/09/26 09:00
PHST- 2006/02/12 00:00 [received]
PHST- 2006/06/26 00:00 [accepted]
PHST- 2006/09/26 09:00 [pubmed]
PHST- 2006/10/19 09:00 [medline]
PHST- 2006/09/26 09:00 [entrez]
AID - S0002-8703(06)00625-9 [pii]
AID - 10.1016/j.ahj.2006.06.028 [doi]
PST - ppublish
SO  - Am Heart J. 2006 Oct;152(4):713.e1-7. doi: 10.1016/j.ahj.2006.06.028.