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首页> 外文期刊>Journal of Cardiovascular Development and Disease >Insights from Second-Line Treatments for Idiopathic Dilated Cardiomyopathy
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Insights from Second-Line Treatments for Idiopathic Dilated Cardiomyopathy

机译：特发性扩张性心肌病二线治疗的见解

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Background: Dilated cardiomyopathy (DCM) is an independent nosographic entity characterized by left ventricular dilatation and contractile dysfunction leading to heart failure (HF). The idiopathic form of DCM (iDCM) occurs in the absence of coronaropathy or other known causes of DCM. Despite being different from other forms of HF for demographic, clinical, and prognostic features, its current pharmacological treatment does not significantly diverge. Methods: In this study we performed a Pubmed library search for placebo-controlled clinical investigations and a post-hoc analysis recruiting iDCM from 1985 to 2016. We searched for second-line pharmacologic treatments to reconsider drugs for iDCM management and pinpoint pathological mechanisms. Results: We found 33 clinical studies recruiting a total of 3392 patients of various durations and sizes, as well as studies that tested different drug classes (statins, pentoxifylline, inotropes). A metanalysis was unfeasible, although a statistical significance for changes upon treatment for molecular results, morphofunctional parameters, and clinical endpoints was reported. Statins appeared to be beneficial in light of their pleiotropic effects; inotropes might be tolerated more for longer times in iDCM compared to ischemic patients. General anti-inflammatory therapies do not significantly improve outcomes. Metabolic and growth modulation remain appealing fields to be investigated. Conclusions: The evaluation of drug effectiveness based on direct clinical benefit is an inductive method providing evidence-based insights. This backward approach sheds light on putative and underestimated pathologic mechanisms and thus therapeutic targets for iDCM management.
机译：背景：扩张型心肌病（DCM）是一个独立的鼻子实体，其特征为左心室扩张和收缩功能障碍导致心力衰竭（HF）。 DCM（iDCM）的特发性形式是在不存在冠状动脉病变或其他已知DCM原因的情况下发生的。尽管在人口统计学，临床和预后方面与其他形式的HF不同，但其目前的药理学治疗方法并没有显着差异。方法：在这项研究中，我们进行了Pubmed库搜索，以研究安慰剂对照的临床研究，并进行事后分析，以收集1985年至2016年的iDCM。我们搜索了二线药理疗法，以重新考虑iDCM管理和查明病理机制的药物。结果：我们发现33项临床研究共招募了3392名不同病程和大小的患者，以及测试不同药物类别（他汀类药物，己酮可可碱，正性肌力药）的研究。尽管已经报告了分子结果，形态功能参数和临床终点治疗变化的统计学意义，但荟萃分析是不可行的。考虑到他汀类药物的多效作用，他汀类药物似乎是有益的。与缺血患者相比，iDCM在更长时间内可以更好地耐受正性肌力药物。常规的抗炎治疗不能明显改善预后。代谢和生长调节仍然是有待研究的诱人领域。结论：基于直接临床获益的药物有效性评估是一种归纳方法，可提供基于证据的见解。这种落后的方法揭示了可能的和被低估的病理机制，从而阐明了iDCM管理的治疗目标。

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