Effect of immunosuppressive therapy in inflammatory cardiomyopathy: data from The Czech Inflammatory Cardiomyopathy Immunosuppressive Trial.

INTRODUCTION: The indications for specific treatment in the cases of inflammatory cardiomyopathy are based on limited data from several small clinical trials. AIM: A comparison of the effect of two dose regimens of combined immunosuppressive therapy by adding them to conventional heart failure therapy and comparing them with conventional heart failure therapy alone in patients with inflammatory cardiomyopathy. METHODS AND STUDY POPULATION: We enrolled 20 patients; mean age 46.10±7.33 years, duration of symptoms <6 months, LVEF ≤40 %, NYHA class II-IV, with biopsy­proven myocarditis. Patients were randomly separated into groups treated with immunosuppressive therapy in addition to conventional heart failure therapy or to a group treated with conventional heart failure therapy alone. Clinical and echocardiographic parameters were evaluated. RESULTS: The baseline values of LVEF in the group of immunosuppressive therapy (LVEF 22.3±4.7 %) were similar to those in the group treated with conventional heart failure therapy (LVEF 21.7±4.7 %; p=0.757). After twelve months there was no statistically significant difference in LVEF between the two studied groups (LVEF 33.7±9.5 % for the immunosuppressive therapy group and 41.3±13.0 % for the conventional therapy group; p=0.175). CONCLUSION: In our study population, we proved no positive effect of combined immunosuppressive therapy on the left ventricular function over 12 months. The main limitation of the study is the small number of enrolled patients (Tab. 4, Fig. 1, Ref. 35).

[Farmacotherapy of hypertension after heart transplantation]. / Farmakoterapie hypertenze po transplantaci srdce.

Heart transplantation is now used for the treatment of severe heart failure. In a long-term patient follow-up, hypertension has been identified as a complication. Incidence of hypertension in patients treated with cyclosporine and prednisone is between 70-90%. Besides the traditional mechanisms (renin-angiotensin system, fluid volume and peripheral resistance), aetiology of hypertension includes negative effect of cardiac denervation, cyclosporine immunosuppression, administration of corticosteroids and nephropathy. There is no night drop in the blood pressure and heart rate. Treatment aims to maintain cyclosporine level as low as possible and, if feasible, to discontinue steroids during the first year. Hypertension is usually treated with a combination therapy. Our own observations suggest that the majority of post-transplantation patients have a dual therapy. Calcium channel blockers should be the treatment of choice as they also have an effect on graft vasculopathy. Angiotenzin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARB), beta-blockers and diuretics are also recommended. Long-acting products should be preferred.