What is the role of medications in the treatment of dilated cardiomyopathy?

Updated: Nov 28, 2018
  • Author: Vinh Q Nguyen, MD; Chief Editor: Gyanendra K Sharma, MD, FACC, FASE  more...
  • Print
Answer

Drug classes used to manage cardiomyopathies include, but are not limited to, the following:

Based on this trial, the 2016 American College of Cardiology/American Heart Association (ACC/AHA) focused update on new pharmacologic therapy for heart failure gives sacubitril-valsartan an IB-R indication for patients with heart failure with reduced ejection fraction to reduce morbidity and mortality. [88]

  • Angiotensin-converting enzyme (ACE) inhibitors

  • Angiotensin II receptor blockers (ARBs)

  • Beta-blockers

  • Aldosterone antagonists

  • Cardiac glycosides

  • Diuretics

  • Nitrates

  • Vasodilators

  • Sacubitril-valsartan (ARNI): In patients with heart failure with reduced ejection fraction (< 40%) with NYHA class II or above, sacubitril-valsartan combination was shown to be superior to enalapril in the reduction of cardiovascular mortality, hospitalization for heart failure, and improvement in symptoms based on the Kansas City Cardiomyopathy Questionaire (KCCCQ). [80]  In the PARADIGM-HF trial, primary outcome of death from cardiovascular causes or hospitalization from heart failure occurred in 21.8% of the angiotensin-neprilysin inhibition (ARNI) (sacubitril-valsartan)-treatment group versus 26.5% in the enalapril-treatment group. ARNI therapy also reduced hospitalization by 21%. Therapy with ARNI was more likely to have symptomatic hypotension but rarely required discontinuation. In contrast, enalapril was associated with high incidence of cough, as well as elevated creatinine levels above 2.5 mg/dL and serum potassium levels above 6 mmol/L. [80] ARNI therapy was not associated with increased risk of angioedema as compared to enalapril. Based on this trial, the 2016 American College of Cardiology/American Heart Association (ACC/AHA) focused update on new pharmacologic therapy for heart failure gives sacubitril-valsartan an IB-R indication for patients with heart failure with reduced ejection fraction to reduce morbidity and mortality. [88]

  • Ivabradine: In the SHIFT study (Systolic Heart failure treatment with the If inhibitor ivabradine Trial), patients with systolic heart failure—and left ventricular fraction (LVEF) below 35%, sinus rhythm, resting heart rate above 70 beats per minute, and who were on maximally tolerated doses of beta-blocker or who were intolerant to beta blockers—treated with ivabradine showed reduction in the primary composite endpoints of cardiovascular death or hospital admission for worsened heart failure. [89]  However, only 23% of patients took the full target beta blocker dose; 56% of patients took over 50% of the target dose. Therefore, it is not certain that ivabradine provides benefit for those on optimum doses of this beta blocker. [90]

  • Antiarrhythmics

  • Human B-type natriuretic peptide

  • Inotropic agents

Anticoagulants may be used in selected patients.


Did this answer your question?
Additional feedback? (Optional)
Thank you for your feedback!