ABSTRACT
OBJECTIVE: To ascertain whether pulmonary hypertension, as assessed noninvasively by continuous-wave Doppler of tricuspid regurgitation, can be an important independent factor in the prognosis of patients with ischemic or idiopathic dilated cardiomyopathy. DESIGN: Cohort study of consecutive patients with dilated cardiomyopathy in whom follow-up was obtained on all survivors for 28 months. SETTING: Outpatient cardiology private practice office in a tertiary care center. PATIENTS: Consecutive sample of 108 patients who presented for a scheduled office visit during a 15-month period. MEASUREMENTS: M-mode, two-dimensional, and Doppler echocardiographic examinations were done on all patients at entry into the study and on survivors 1 year later. All examinations included extensive pulsed- and continuous-wave Doppler evaluation for tricuspid regurgitation. MAIN OUTCOME MEASURES: Overall mortality, mortality due to myocardial failure, and hospitalization for congestive heart failure. RESULTS: Twenty-eight patients had a high velocity of tricuspid regurgitation (greater than 2.5 m/s), and 80 patients had a low velocity (less than or equal to 2.5 m/s). After 28 months of follow-up, the mortality rate was 57% in patients with a high velocity compared with 17% in patients with a low velocity (difference of 40%, 95% CI, 20% to 60%). Hospitalization for congestive heart failure occurred in 75% and 26% of patients, respectively (difference of 49%, CI, 30% to 68%). Eighty-nine percent of patients with a high velocity either died or were hospitalized compared with only 32% of patients with a low velocity (difference of 57%, CI, 42% to 72%). The peak velocity of tricuspid regurgitation was the only prognostic variable selected using stepwise logistic regression models for the three outcome events. CONCLUSION: Noninvasive assessment of pulmonary hypertension using continuous-wave Doppler of tricuspid regurgitation can predict morbidity and mortality in patients with ischemic or idiopathic dilated cardiomyopathy.
Subject(s)
Cardiomyopathy, Dilated/mortality , Hypertension, Pulmonary/mortality , Adult , Aged , Aged, 80 and over , Blood Flow Velocity , Cardiomyopathy, Dilated/complications , Cardiomyopathy, Dilated/physiopathology , Echocardiography , Female , Hospitalization , Humans , Hypertension, Pulmonary/complications , Hypertension, Pulmonary/physiopathology , Logistic Models , Male , Middle Aged , Prognosis , Prospective Studies , Tricuspid Valve Insufficiency/mortality , Tricuspid Valve Insufficiency/physiopathologyABSTRACT
Although procainamide has been available, and used, in the treatment of atrial and ventricular arrhythmias for approximately thirty years, its short half-life has made it less than optimal for long-term arrhythmia management in ambulatory patients. Currently available sustained-release preparations provide the same therapeutic benefit with a more tolerable dosage schedule. The pharmacology of procainamide and its basic electrophysiologic properties, dosage schedules, and toxicity are discussed. Finally, the current indications for its use are reviewed.
