Abstract
Aim. To evaluate the role and importance of the functional and etiological diagnosis in determining the surgical treatment of patients with dilated cardiomyopathy (DCM). Material and methods. We examined 156 patients (40 women and 116 men) with dilated cardiomyopathy (DCM) aged 18-75 (average age — 48.8+/- 11.4) for the period from 2008 to 2013. The history of the disease averaging 54.8 +/-5.7 months; 15 (10%) of patients were in functional class II, 49 (31%) — in class III, 92 (59%) — in class IV. Results. The mean end-diastolic LV diameter was 7.45+/-1.2 cm, ejection fraction — 26.7+/- 2.1%. We performed blood PCR analysis in all the patients: Genome of herpes simplex virus type 1 was reported in 14 (9%), type 2 — in 7 (4%), type 6 — in 12 (8%) patients; of cytomegalovirus — in 20 (13%), of Epstein-Barr virus — in 24 (15%), of parvovirus B19 — in 29 (19%); we performed morphological study of the myocardium to detect cardiotropic viruses genome in 66 patients: genome of herpes simplex virus type 6 was found in 13 (23%), of cytomegalovirus — in 7 (12%), of Epstein-Barr virus — in 9 (15%), of parvovirus B19 — in 24 (42%). Depending on etiological factors, initial functional state of the patient as well as the severity of valvular regurgitation and the degree of interventricular dyssynchrony, 24 patients were implanted with cardioverter defibrillator (ICD) and 38 patients — with cardiac resynchronization therapy with cardioverter defibrillator function (CRT-D): in total, 62 patients with DCM; 24 patients underwent organ conserving reverse cardiac remodeling; orthotopic heart transplantation was performed in 13 patients; conservative treatment group consisted of 57 patients with DCM for whom surgical treatment was not recommended or impossible at the moment of the examination. Conclusion. These data indicate that application of complex etiological and functional diagnostics allows us not only to make nosological diagnosis of patients with DCM but also to determine the type of treatment and prognosis.
Highlights
We examined 156 patients (40 women and 116 men) with dilated cardiomyopathy (DCM) aged 18–75 for the period from 2008 to 2013
Геном вируса простого герпеса 1 типа был отмечен у 14 (9%) пациентов, 2 типа — у 7 (4%), герпеса 6 типа — у 12 (8%), цитомегаловируса — у 20 (13%), Эбштейн-Барра — у 24 (15%), парвовируса В19 — у 29 (19%)
Оценивая результаты хирургического лечения пациентов с синдромом дилатационной кардиомиопатией (ДКМП), следует отметить, что такую органосохраняющую операцию, как обратное ремоделирование сердца приходится выполнять больным любой возрастной группы с исходно низкими показателями Фракция выброса ЛЖ (ФВ), гемодинамически значимыми клапанными пороками сердца и клиническими признаками бивентрикулярной недостаточности без признаков активного вирусного миокардита и подозрения на генетическую природу ДКМП
Summary
Приведенные данные свидетельствуют о том, что применение комплексной этиологической и функциональной диагностики позволяет не только поставить нозологический диагноз при ДКМП, но и определить вид лечения и прогноз. Ключевые слова: дилатационная кардиомиопатия (ДКМП), сердечная недостаточность, обратное ремоделирование сердца, эндомиокардиальная биопсия, кардиовертер-дефибриллятор (ИКД), ресинхронизирующая терапия (CRT-D). [8] около 50% пациентов с синдромом ДКМП не имеют определенно установленной причины заболевания миокарда.
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