SHIFTING THE PARADIGM FOR THE TREATMENT OF DILATED CARDIOMYOPATHY

Dilated cardiomyopathy (DCM) has emerged as a major health problem dur ing the past two decades In spite of recent advances, it has become cl ear that the underlying heart disease is relentlessly progressive in a lmost all patients who develop symptoms of overt failure; morbidity an d mortality continues to be unacceptably high with an incidence of app roximately approximately 30% for death or hospital admission at one ye ar. Cardiac transplantation remains the only current prospect for dram atically improving survival in many patients. Trying to enhance cardia c function during the later stages of heart failure is ultimately frui tless; it cannot be done over the long term. The solution to failure l ies in defining and preventing its causes or arresting and reversing i ts evolution. We propose a model where the target for therapeutic inte rvention becomes the arrest of progressive myocardial disease througho ut the course of the the cardiomyopathy. In this paradigm, the selecti on of therapeutic agents for the treatment of heart failure takes into consideration both the stage of the disease and differences in pathog enesis. In addition it broadens our approach from one which focuses on enhancing myocardial function to one which encompasses strategies whi ch are designed to inhibit the progressive loss of myocytes and the in exorable deterioration of the failing myocardium.