BMJ  2006;333:1014 (11 November), doi:10.1136/bmj.333.7576.1014

Practice

Short cuts

End stage heart failure may be reversible

End stage heart failure is a point of no return for most patients, but researchers from the UK now report preliminary success with intensive drug treatment combined with a ventricular assist device to offload the left ventricle. They treated 15 patients, and 11 recovered well enough to have their device removed after a mean of 320 days. One patient died almost immediately from intractable arrhythmias, but the other 10 survived for more than two years, and nine of them survived for four. Of the nine who survived for four years, eight had no recurrence of their heart failure. They had a mean left ventricular ejection fraction at five years of 64%.

Most of the 15 patients in this series had non-ischaemic dilated cardiomyopathy, and none had active myocarditis. The carefully controlled drug regimen was designed specifically to reverse the damaging remodelling that occurs in the failing heart and included lisinopril, carvedilol, spironolactone, losartan, and clenbuterol.

Ten of the patients in this series recovered better and for longer than patients in other anecdotal reports, but it's still early days, warns a linked editorial (pp 1922-5). This study had no controls, and the authors treated only a small number of hand picked patients, some of whom did not respond.

References

N Engl J Med 2006;355:1873-84[Abstract/Full Text]

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