Dilated Cardiomyopathy - Treatment and Outcome

The impact of changing medical treatment on transplant-free survival in pediatric dilated cardiomyopathy. Paul F Kantor, Jonathan R. Abraham, Anne I. Dipchand, Lee N. Benson, Andrew N. Redington. JACC 2010;55:1377-84.

Single institution. Retrospective review of all patients over 30 years (1976-2005).
n-189, 44 died. 24 had transplant. 10 were lost to follow up. So, the study cohort n=111.
2-yr & 5-yr transplant-free survival = 63.6% and 56.3% respectively.

5-yr survival:
Digoxin only - 67.5%
Digoxin & ACEi - 57.2%
ACEi & BB - 58.5%

Multivariate analysis:
Low LVEF at presentation is associated with increased risk of death or transplantation.
End point was not influenced by time era or treatment strategy.

Natural History of Endocarditis Vegetation

1) Natural history of vegetations during successful medical treatment of endocarditis.
Cedric Vuille, Mark Nidorf, Arthur Weyman and Michael Picard.
AHJ 1994;128:1200-9

41 vegetations in 32 patiens were followed.
At the end of initial treatment,
Resolution: 29 vegetations (70%) were still present.
Size: No change in size in 59%
Echogenicity: Vegetations appeared denser in 52% of them.
Morphologic changes were not associated with outcome.
Presence of severe valvar regurgitation was associated with late valve replacement.
Persistence of vegetation is common after successful treatment and is not independently associated with late complications.

2) Natural history of tricuspid valve endocarditis: A two dimensional echocardiographic study.
Leonard ginzton, Robert Siegel & Michael Criley
AJC 1982;49:1853-9.

Very old study, comparing M-mode and 2-D echo for tricuspid valve IE.
n=16 patients.
(5 of them needed surgery or died)
Change in vegetation size from 8 patients is depicted in this figure.
Note: from only 8/16 pts. Surgical patients are inlcuded!!! What does that mean...did the surgeon not remove them?!