• patients with dilated cardiomyopathy of any cause, with depressed left ventricular function (ejection fraction < 40%), in NYHA class II–III, clinically stable on angiotensin converting enzyme inhibitor, diuretic, and digitalis treatment
|
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Which patients are more likely to benefit? |
• NYHA class II−III |
• history of hypertension |
• heart rate > 90 beats/min |
• symptom duration < 24 months |
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Which patients are less likely to benefit? |
• advanced heart failure (high wedge pressure, hypotension, cardiac index < 2.5 l/min/m2) |
• symptom duration > 24 months |
• severe biventricular dysfunction |
• systolic blood pressure < 100 mm Hg |
• heart rate < 70 beats/min |
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For which patients do uncertainties still exist (scarce data from trials)? |
• elderly patients (> 75 years) |
• NYHA class IV |
• comorbidities (diabetes, chronic obstructive pulmonary disease, renal failure, peripheral vasculopathy) |
• asymptomatic left ventricular dysfunction |
• heart failure caused by valvar disease or diastolic dysfunction |
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What are the contraindications? |
• severe chronic obstructive pulmonary disease |
• first degree AV block (PQ > 0.28 seconds) |
• second degree AV block (Mobitz 2 or advanced) |
• patients being treated with intravenous inotropes |
• heart rate < 50 beats/min |
• systolic blood pressure < 90 mm Hg |