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Dilated cardiomyopathy, characterized by enlargement
of the cardiac chambers and depressed ventricular function, is increasing in prevalence as the
average age of affluent populations is increasing, and continues to be a common cause of heart
failure and high mortality. As a result of a better understanding of the underlying pathophysiologic
mechanisms responsible for the progression of the disorder, major advances have been achieved
in the management of both cardiac symptoms and triggering factors that lead to worsening of
ventricular function. Current therapeutic options consist mainly of drug therapy, which has expanded
remarkably over the past several years, most notably with respect to the use of angiotensin
converting enzyme inhibitors and beta adrenergic blockers. However, a sizable number of patients
continue to suffer from poor quality of life due to severe limitations during effort and daily activities.
Non pharmacological interventions are also available to improve symptoms in patients with dilated
cardiomyopathy refractory to drugs. In this realm, heart transplantation remains the gold standard
although, because of scarcity of heart donors, this option is restricted to a highly selected population.
Among the alternatives, cardiomyoplasty remains controversial, and implantable left ventricular
assist devices are still under early evaluation. In this background, cardiac resynchronisation therapy,
as achieved with atrio-biventricular pacing, has been proposed with an initial goal to improve
hemodynamics and quality of life.
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