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The algorithm of diagnosis and treatment for patients with dilated cardiomyopathy

Vaykhanskaya T. G.1, Kurushko T. V.1, Sivitskaya L. N.2, Danilenko N. G.2, Shestakova L. G.1, Frolov A. V.1
1 – State Institution Republican Science and Practice Center “Cardiology”, R. Luxemburg 110, Minsk 220036, Republic of Belarus
2 – State Science Institution, “Institute of Genetics and Cytology of Belarus National Academy of Sciences”, Akademicheskaya 27, Minsk 220072, Republic of Belarus

Keywords: dilated cardiomyopathy, microvolt T-wave alteration, heart rate turbulence, lamin A/C gene, sudden cardiac death, cardiac resynchronization therapy, cardioverter-defibrillator

DOI: 10.18087/rhfj.2015.6.2165

Background. The major causes of death from dilated cardiomyopathy (DCMP) are sudden cardiac death (SCD) and decompensated congestive HF. Cardiac resynchronization therapy (CRT) using biventricular stimulation allows increasing survival of patients with systolic dysfunction and HF. An important issue of CRT is the lack of effect in 30–37 % of patients. This article present results of a multifactorial regression analysis for risk markers of SCD and predictors of response to CRT in patients with DCMP. Aim. To develop an algorithm for diagnosis and treatment and for selection of an optimal electrophysiological therapy in patients with familial and idiopathic DCMP based on the use of 4th generation digital electrocardiography and molecular genetic analysis of the lamin gene. Materials and methods. The study included 207 patients with DCMP (males, 81.2 %; 48.9±11.4; NYHA FC, 3.01±0.29; LV EF, 28.6±9.12 %). A comprehensive examination, including EchoCG, Holter ECG monitoring (HM); 7‑min ECG recording using the Intecard-7 analysis of heart rate turbulence (HRT) and microvolt T-wave alternations, was performed for all patients. According to the developed algorithm for detection of DCMP a virological screening (PCR method) was used for 143 patients who noticed a connection of first HF symptoms with a past viral infection; a genetic study (SSCP and sequencing) of the lamin A / C gene (LMNA) was performed in 116 patients (18 probands with familial DCMP and 98 idiopathic cases with primary manifestation of heart rhythm and conductance disorders). Results. The regression analysis included all analyzed parameters (ECG / HM, EchoCG, virus positivity, and changes in the lamin gene). The multifactorial analysis showed that the index of left ventricular systolic dysfunction (LV EF ≤21 %), a positive mTWA test (mTWA ≥35.4 mcV), nucleotide replacements rs4641С / Т in exon 10 of the LMNA gene, and abnormal HRT (TO ≥1.31 %) were independent predictors of SCD. A combination of these factors was used for risk stratification, and a group of potential candidates for CVD implantation was identified. OR and ROC analyses identified an independent predictor for a positive response to CRT, duration of the RS interval in the chest lead V1 with a threshold value of RS ≥127 ms (OR, 3.94; 95 % CI, 1.65–9.23; p<0.001), as an additional criterion supplementing standard indications for CRT to enhance the method effectiveness. Conclusion. Based on the obtained data and evaluating the identified risk predictors for SCD and the ECG marker for CRT effectiveness, an algorithm was developed for selection of an optimum electrophysiological treatment (CVD implantation, CRT-P, or CRT-D) of patients with DCMP.
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Vaykhanskaya T. G., Kurushko T. V., Sivitskaya L. N., Danilenko N. G., Shestakova L. G., Frolov A. V. The algorithm of diagnosis and treatment for patients with dilated cardiomyopathy. Russian Heart Failure Journal. 2015;16 (6):344–359

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