THE SIGNIFICANCE OF FUNCTIONAL AND ETIOLOGICAL DIAGNOSTIC FOR TREATMENT STRATEGY DECISION IN PATIENTS WITH DILATED CARDIOMYOPATHY

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.

1. Blagova O. V. Complex clinical-morphological approach to the nosological diagnosis "idiopathic" arrhythmias and syndrome DC and their treatment. Avtoreferat Diss. Prof. Madauk. M., 2013, 51p. Russian (Благова О. В. Комплексный клинико-морфологический подход к нозологической диагностике "идиопатических" аритмий и синдрома ДКМП и их лечению. Автореферат Дисс. Докт. Мед.наук. М., 2013, 51 с).

2. Dzemeshkevich SL, Stevenson LY Myocardial dysfunction and heart surgery. M: GEOTAR- Media, 2009. Russian (Дземешкевич С. Л., Стивенсон Л. У Дисфункции миокарда и сердечная хирургия. М.: ГЭОТАР-Медиа, 2009).

3. Rizun LI, Abugov SA, Dzemeshkevich SL, et al. Coronarogenic dilated cardiomyopathy after surgery reverse remodeling of the heart. Cardiology 2013; 12: 52-57. Russian (Ризун Л. И., Абугов С. А., Дземешкевич С. Л. и др. Некоронарогенная дилатационная кардиомиопатия после операции обратного ремоделирования сердца. Кардиология 2013; 12: 52-57).

4. Antunes MJ, Prieto D, Sola E, et al. Cardiac transplantation: five years' activity. Rev Port Cardiol. 2010; 29 (5): 731-48.

5. Cleland JGF, Daubert JC, Erdmann E, et al. Long-term effects of cardiac resynchronization therapy on mortality in heart failure [the CArdiac REsynchronization-Heart Failure (CARE- HF) trial extension phase]. Eur Heart J. 2006; 27: 1928-32.

6. Elliot P. The 2006 American Heart Association Classification of Cardiomyopathies Is Not the Gold Standard. Circulation. Heart Failure. 2008; 1: 77-80.

7. Felker GM, Thompson RE, Hate M, et al. Underlying causes and long-term survival in patients with initially unexplained cardiomyopathy. N Engl J Med 2000; 342: 1077-84.

8. Hazebroek М, Dennert R, Heymans S. Idiopathic dilated cardiomyopathy: possible triggers and treatment strategies Neth Heart J. 2012 August; 20 (7-8): 332-5.

9. Luk A, Metawee M, Ahn E, et al. Do clinical diagnoses correlate with pathological diagnoses in cardiac transplant patients? The importance of endomyocardial biopsy. Can J Cardiol. 2009; 25 (2): 48-54.