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Maurizi N, Chiriatti C, Fumagalli C, Targetti M, Passantino S, Antiochos P, Skalidis I, Chiti C, Biagioni G, Tomberli A, Giovani S, Coppini R, Cecchi F, Olivotto I. Real-World Use and Predictors of Response to Disopyramide in Patients with Obstructive Hypertrophic Cardiomyopathy. J Clin Med 2023; 12:jcm12072725. [PMID: 37048808 PMCID: PMC10095445 DOI: 10.3390/jcm12072725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 03/26/2023] [Accepted: 04/03/2023] [Indexed: 04/09/2023] Open
Abstract
Background: Although disopyramide has been widely used to reduce left ventricular outflow obstruction (LVOTO) and to improve symptoms in patients with obstructive hypertrophic cardiomyopathy (oHCM), its use in real world as well as patient characteristics associated with a positive treatment response are still unclear. Methods: From 1980 to 2021, 1527 patients with HCM were evaluated and 372 (23%) had a LVOTO with active follow-up. The efficacy and safety of disopyramide were assessed systematically during 12 months (2-, 6-, and 12-month visits). Responders were patients with a final NYHA = I and a LVOTO < 30 mmHg; incomplete responders were those patients with NYHA > I and a LVOTO < 30 mmHg; and non-responders were symptomatic patients with no change in functional class NYHA and a LVOT gradient > 30 mmHg. Results: Two-hundred-fifty-four (66%) patients were in functional class NYHA I/II and 118 (34%) in NYHA III/IV. A total of 118/372 (32%, 55 ± 16 years) underwent disopyramide therapy. Twenty-eight (24%) patients responded to therapy, 39 (33%) were incomplete responders, and 51 (43%) did not respond. Responder were mainly patients in functional NYHA class I/II (24/28, 86%), whereas incomplete responders and non-responders were more often in functional NYHA class III/IV (50/54 (93%)). An independent predictor of response to disopyramide treatment was the presence of NYHA I/II at the initiation of therapy (HR 1.5 (95% CI 1.1–4.5), p = 0.03). No major life-threatening arrhythmic events or syncope occurred, despite 19 (16%) patients showing reduced QTc from baseline, 19 (16%) having no difference, while 80 (69%) patients had prolonged QTc interval. Thirty-one (26%) patients experienced side effects, in particular, 29 of the anticholinergic type. Conclusions: Disopyramide was underused in oHCM but effective in reducing LVOTO gradients and symptoms in slightly symptomatic patients with less severe disease phenotype with a safe pro-arrhythmic profile.
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Affiliation(s)
- Niccolò Maurizi
- Department of Clinical and Experimental Medicine, University of Florence, 50121 Florence, Italy
- Service of Cardiology, University Hospital of Lausanne, 1009 Lausanne, Switzerland
| | - Chiara Chiriatti
- Cardiomyopathy Unit, Careggi University Hospital, 50134 Florence, Italy
| | - Carlo Fumagalli
- Cardiomyopathy Unit, Careggi University Hospital, 50134 Florence, Italy
| | - Mattia Targetti
- Cardiomyopathy Unit, Careggi University Hospital, 50134 Florence, Italy
| | - Silvia Passantino
- Cardiomyopathy Unit, Careggi University Hospital, 50134 Florence, Italy
| | - Panagiotis Antiochos
- Service of Cardiology, University Hospital of Lausanne, 1009 Lausanne, Switzerland
| | - Ioannis Skalidis
- Service of Cardiology, University Hospital of Lausanne, 1009 Lausanne, Switzerland
| | - Chiara Chiti
- Cardiomyopathy Unit, Careggi University Hospital, 50134 Florence, Italy
| | - Giulia Biagioni
- Cardiomyopathy Unit, Careggi University Hospital, 50134 Florence, Italy
| | - Alessia Tomberli
- Cardiomyopathy Unit, Careggi University Hospital, 50134 Florence, Italy
| | - Sara Giovani
- Cardiomyopathy Unit, Careggi University Hospital, 50134 Florence, Italy
| | - Raffaele Coppini
- Department NeuroFarBa, University of Florence, 50121 Florence, Italy
| | | | - Iacopo Olivotto
- Department of Clinical and Experimental Medicine, University of Florence, 50121 Florence, Italy
- Service of Cardiology, Meyer Children’s Hospital IRCCS, 50139 Florence, Italy
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de la Torre JC. Hemodynamic Instability in Heart Failure Intensifies Age-Dependent Cognitive Decline. J Alzheimers Dis 2020; 76:63-84. [PMID: 32444552 DOI: 10.3233/jad-200296] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
This review attempts to examine two key elements in the evolution of cognitive impairment in the elderly who develop heart failure. First, major left side heart parts can structurally and functionally deteriorate from aging wear and tear to provoke hemodynamic instability where heart failure worsens or is initiated; second, heart failure is a major inducer of cognitive impairment and Alzheimer's disease in the elderly. In heart failure, when the left ventricular myocardium of an elderly person does not properly contract, it cannot pump out adequate blood to the brain, raising the risk of cognitive impairment due to the intensification of chronic brain hypoperfusion. Chronic brain hypoperfusion originates from chronically reduced cardiac output which progresses as heart failure worsens. Other left ventricular heart parts, including atrium, valves, myocardium, and aorta can contribute to the physiological shortfall of cardiac output. It follows that hemodynamic instability and perfusion changes occurring from the aging heart's blood pumping deficiency will, in time, damage vulnerable brain cells linked to specific cognitive regulatory sites, diminishing neuronal energy metabolism to a level where progressive cognitive impairment is the outcome. Could cognitive impairment progress be reversed with a heart transplant? Evidence is presented detailing the errant hemodynamic pathways leading to cognitive impairment during aging as an offshoot of inefficient structural and functional heart parts and their contribution to heart failure.
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Affiliation(s)
- Jack C de la Torre
- Department of Psychology, University of Texas at Austin, Austin, TX, USA.,University of Valencia, Valencia, Spain
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Passantino S, Maurizi N, Fedele E, Marchi A, Ghiselli L, Chiriatti C, Fumagalli C, Brambilla A, Guccione P, Favilli S, Olivotto I. Cardiomyopathies in children – inherited heart muscle disease. PROGRESS IN PEDIATRIC CARDIOLOGY 2018. [DOI: 10.1016/j.ppedcard.2018.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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