A prospective, randomized, controlled trial of prednisone for dilated cardiomyopathy

Article Abstract:

Idiopathic dilated cardiomyopathy refers to a disease of the heart muscle that causes blood pressure abnormalities and enlargement of the ventricles, the heart's pumping chambers. The end result of this disease process of unspecific origin can include various problems with the electrical conduction system of the heart, inability to pump the quantity of blood demanded by the body (heart failure), embolism, and finally, death. Data from previous studies show that 50 percent of patients with this condition died within two years and 80 percent were dead by the eighth year following diagnosis. Tissue analysis has shown that the heart muscle may be involved in an inflammatory process, carditis. The value of the anti-inflammatory drug prednisone as a treatment for this condition was evaluated. One hundred and two patients diagnosed with dilated cardiomyopathy were evaluated by noninvasive tests such as thyroid function, blood chemistry, nuclear scanning (heart physiology), echocardiography or ultrasound (heart structure), Holter monitoring (electrocardiograms obtained during an active day), and treadmill stress testing. The subjects also underwent a series of invasive examinations that included coronary arteriography, the insertion of a catheter, a tube, into the heart for the purposes of injecting dye to examine function and structure, and removing of heart tissue for microscopic examination. Patients that continued to deteriorate during the study when possible obtained transplanted hearts from a cadaver. The patients were divided into two groups: one receiving prednisone (cortisone) and another group left untreated. Based on findings, patients were either classified as reactive (that is, they showed signs of inflammation) or nonreactive. Reactive patients did considerably worse than nonreactive patients. Reactive patients responded significantly to the prednisone treatment at first, but the value of the treatment diminished overtime and at 9 months there was no significant difference between groups. There was a greater number of deaths and transplantations in the prednisone-treated group, and although not statistically significant, these data remain a concern. Prednisone is not judged to have clinical benefit in cases of dilated cardiomyopathy and should not be used as a standard treatment for this condition.

Care and treatment, Evaluation, Heart diseases, Cardiomyopathy, Myocardial diseases, Prednisone, Outcome and process assessment (Health Care), Outcome and process assessment (Medical care)

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Promotion and subsequent inhibition of plasminogen activation after administration of intravenous endotoxin to normal subjects

Article Abstract:

This study explores the role that toxic products produced by bacteria (endotoxins) may play in blocking the normal clotting mechanism. Normal volunteers (19 subjects) were given endotoxins intravenously. Several measurements of various important compounds in the clotting and clot removal (fibrinolytic) systems were measured. One of these factors, tissue plasminogen activator, was found to rise within one hour of treatment. Another factor, alpha(sub2)-plasmin increased sevenfold by the third hour following treatment. Several other factors were measured which either rose slightly or showed no change in concentration during the experimental period. The activity of the tissue plasminogen activator could be abolished in tissue culture with a immunologic reagent that only works against this compound confirming that the demonstrated activity in the living individuals was due to this compound. The authors conclude that endotoxin activates the clot removing mechanism of the body (the fibrinolytic system), and that this endotoxins may act soon after release to decrease clotting in the vascular system (thrombosis).

Prevention, Tissue plasminogen activator, Thrombosis, Fibrinolytic agents, Blood chemical analysis, blood, Circulating anticoagulants, Plasmin

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The cardiovascular response of normal humans to the administration of endotoxin

Article Abstract:

This study evaluated the cardiovascular effects of endotoxemia (septic shock) in humans. Septic shock is a major, life-threatening complication of serious bacterial infections. Septic shock is also a major cause of irreversible hypotension (low blood pressure), multiple organ dysfunction and death. One of the marked abnormalities caused by septic shock is cardiovascular problems. To characterize cardiovascular performance during the initial stages of endotoxemia, the researchers monitored normal volunteers with thermodilution pulmonary-artery catheters and simultaneous radionuclide cineangiography after the intravenous administration of endotoxin. The study demonstrated that the administration of endotoxin to normal humans results in a hyperdynamic cardiovascular state, characterized by an elevated cardiac index and heart rate, and by a decreased average arterial pressure and systemic vascular-resistance index.

Analysis, Electrocardiography, Vascular resistance, Blood pressure, Septic shock, Tumor necrosis factor, Blood pressure measurement, Heart function tests, Cardiological manifestations of general diseases

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