Historical evolution: from the 80s to today
La Dilated Cardiomyopathy Idiopathic heart failure has always been considered a very serious condition, with mortality rates comparable to those of some of the most serious cancers. In the 80s, 5-year survival was less than 50%! In approximately half of cases, death was due to an intractable progression of the severity of heart failure, while in the other half, it was related to cardiac arrest, mostly caused by ventricular fibrillation.
Drug therapies: advances that have changed the prognosis
Fortunately, new therapeutic interventions have radically altered the progression of this disease and led to significant improvements in survival and quality of life. In particular, numerous new drugs, initially introduced for the treatment of hypertension, have been demonstrated to be effective in patients with heart failure: ACE inhibitors and angiotensin receptor blockers (ARBs), but especially beta-blockers. Further recent improvements have been achieved with the use of anti-aldosterone drugs and, more recently, with neprilysin inhibitors combined with ARBs (sacubitril-valsartan). However, research continues. In recent years, some studies have shown that the addition of certain drugs from the "glifozine" group, already marketed for blood sugar control in diabetic patients, allows for further significant improvements not only in diabetic patients with heart failure but also in non-diabetic patients.
Implantable Devices: ICDs and CRTs in the Management of Dilated Cardiomyopathy
Over the past twenty years, the contribution of implantable devices has also been fundamental, such as the defibrillator (ICD), which reduces the risk of sudden death by restoring the heartbeat after cardiac arrest, and/or the biventricular pacemaker (CRT or cardiac resynchronization therapy), which can improve the strength of contraction (also called "systolic function") of the left ventricle in patients with left bundle branch block, and even restore the heart to normal size. Finally, of course, the most extreme measure: heart transplant.
Current prognosis: 10-year survival rate over 85%
Improvement in 10-year transplant-free survival rate in patients with dilated cardiomyopathy based on date of first diagnosis.
Today, 10-year heart transplant-free survival exceeds 85% of cases. But given that cardiac transplantation now makes it possible to extend the life of patients by decades also thanks to modern immunosuppressive therapy, which avoids "rejection", the real mortality at 10 years of patients with dilated cardiomyopathy has dropped well below the 10%.
There are not many other examples of such remarkable successes in the management of pathologies of comparable severity.
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The role of specialized centers in the management of dilated cardiomyopathy
These results therefore demonstrate how the evolution of pharmacological and non-pharmacological treatment of Dilated Cardiomyopathy has led to an enormous gain in terms of survival and quality of life for patients in the real world. Obviously, this is also made possible by the organizational context and the regular periodic control of patients, who require continuous and expert surveillance of their clinical status to address and use in the best way, in a personalized way, the resources that pharmacotherapy and clinical research have. made available.
Dr. Gabriele Castelli
Cardiomyopathy Unit – AOU Careggi Florence
