Ventricular remodeling for preventing future heart failure

Posted By  CCF CARDIO MD sc on January 21, 1998 at 13:54:53:

In Reply to: Ventricular remodeling for preventing future heart failure posted by Ralph McCoy on January 14, 1998 at 21:39:04:

: I had heart failure due to leaky valves in October 1995 and I am now on several medications (an ace inhibitor, a diurectic, a beta blocker, digitalis, and an anti arrythmic) and I am doing very well and working full time.  A heart cath showed that my heart arteries were clean.  My heart is very enlarged and my cardiologist suggested that a heart transplant might be in my future.
  Will ventricular remodeling ever be offered to someone in fairly good health as a prevention to future heart failure possibly requiring a heart transplant?

[CCF Cardio MD sc]

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Dear Mr. Mccoy
There are as yet no ongoing studies evaluating the validity of performing "Left ventricular remodeling" to prevent the development of decompensated heart failure and the eventual need for cardiac transplantation in patients with dilated cardiomyopathy. As previously discussed in this forum this procedure is currently being limited to those patients who are severely symptomatic ( shortness of breath at rest on with minimal exertion) and who would otherwise be a candidate for cardiac transplantation. The Cleveland Clinic experience has dictated that the patients offered this procedure, be a candidate for cardiac transplantation as we have seen that a percentage of those who do undergo a procedure may have a deterioration of their symptoms that might require them to be implanted with a ventricular assist device and ultimately undergo heart transplantation. From your brief description it does not seem that you would be at a stage where this procedure would be offered to you. There is however a current study where a procedure called cardiomyoplasty is being offered to patients who are only mildly symptomatic in an attempt to prevent further dilatation and deterioration of the heart. This study called C-SMART is being offered in numerous centers around the country and it involves the wrapping of one of the chest wall muscles around the heart to help the heart in its contractions. This is still however in the trial stage and is obviously not the standard of care at this point.  I think that continuing on your current medication regimen which is the standard of care at this point in time is a very good option. I do not know how long you have been diagnosed with this condition but I would like to stress that on patients recently diagnosed with this condition " dilated cardiomyopathy", a fair proportion up to 30% remain stable while an equal number might even improve.
I hope you find this information useful. If you have any further questions or would to be seen by one of our heart failure specialists here at the Cleveland Clinic please free to call 1-800-CCF-CARE to set this up.
Information in this forum is intended for general purposes only, specific diagnosis and treatment modalities should be reserved for physicians directly involved in patient care.