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A Journal on Internal Medicine

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Panminerva Medica 2002 March;44(1):23-5

language: English

Treatment of heart failure and ascites with ultrafiltration in patients with intractable alcoholic cardiomyopathy

Bilora F., Petrobelli F., Boccioletti V., Pomerri F. *

From the Department of Medical and Surgery Science
*Institute of Radiology University of Padua, Padua, Italy


Background. In West­ern coun­tries the ­excess of alco­hol ­intake caus­es, sec­on­dary, non ischaem­ic car­di­om­yo­pa­thy and cir­rho­sis. Frequently, ther­a­py is not effec­tive so ultra­fil­tra­tion was ­tried on ­patients affect­ed, ­with pos­i­tive ­effects on ­life qual­ity. We ­tried to ver­i­fy util­ity and tol­er­ance to per­i­to­neal ultra­fil­tra­tion in a ­group of sub­jects affect­ed by ­heart fail­ure sec­on­dary to alco­hol­ic car­di­om­yo­pa­thy, refrac­tary to con­ven­tion­al ther­a­py.
Methods. Sixteen ­patients (14 ­males, 2 ­females) ­with ­heart fail­ure and ­ascites affect­ed by alco­hol­ic car­di­om­yo­pa­thy ­were stud­ied. All sub­jects ­were in IV ­class ­NYHA (New York Heart Association); ejec­tion frac­tion (EF) was eval­u­at­ed by ech­o­car­di­o­gram and ­ascites by abdom­i­nal ultra­sound. Patients ­were sub­mit­ted to clin­i­cal ­exam, ­body ­weight, abdom­i­nal cir­cum­fer­ence, diu­re­sis and rou­tine bio­hu­mo­ral ­exams, elec­tro­car­di­o­gram and ­chest X-ray. Subsequently ­they under­went inter­mit­tent noc­tur­nal per­i­to­neal dial­y­sis ­with a chang­ing ­cycle of 6-12 ­hours per ses­sion. After 5 ­days, sub­jects ­were ­checked ­through ech­o­car­di­o­gram and abdom­i­nal ultra­sound.
Results. The ­patients ­mean age was 56.7±3.2 ­years. After ultra­fil­tra­tion, all sub­jects ­showed ­decreased ­body ­weight, abdom­i­nal cir­cum­fer­ence and ­urea; ­there was an ­increase of diu­re­sis and Natriuria. Fifteen sub­jects ­entered III ­NYHA ­class with­out vari­a­tion of EF; all of ­them ­showed clin­i­cal and ech­o­graph­ic reduc­tion of ­ascites. Mean ultra­fil­tra­tion quan­tity was 6.084 ml ­with ­mean dial­y­sis ­hours 20; 7.36% of ­patients had ­fever ­that dis­ap­pared with­in 24 ­hours ­with anti­bi­o­tic ther­a­py. All sub­jects ­referred to ­feel ­well and the ­mean hos­pi­tal­iza­tion peri­od was of 7 day in ­spite of the usu­al 22 ­days.
Conclusions. We sug­gest per­i­to­neal dial­y­sis for ­patients ­with con­ges­tive ­heart fail­ure and ­ascites ­caused ­from alco­hol­ic car­di­om­yo­pa­thy refrac­to­ry to con­ven­tion­al ther­a­py.

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