Asunto(s)
Diabetes Mellitus Tipo 2/mortalidad , Electrocardiografía , Hipertrofia Ventricular Izquierda/complicaciones , Diabetes Mellitus Tipo 2/complicaciones , Femenino , Salud Global , Humanos , Hipertrofia Ventricular Izquierda/mortalidad , Hipertrofia Ventricular Izquierda/fisiopatología , Masculino , Persona de Mediana Edad , Pronóstico , Tasa de Supervivencia/tendencias , Factores de TiempoRESUMEN
A insuficiência renal crônica é um modelo clínico de hipertrofia ventricular. Os pacientes renais crônicos apresentam uma expectativa de vida significativamente reduzida. A principal causa de morte nessa situação clínica é a doença cardiovascular e a hipertrofia ventricular esquerda é um potente preditor de eventos cardiovasculares e de mortalidade. Pacientes em diálise com baixa escolaridade tem expectativa de vida adicionalmente reduzida. Essa associação entre baixa escolaridade e mortalidade cardiovascular é bem documentada na população geral. Também já foi demonstrado que pessoas de baixa escolaridade apresentam hipertrofia ventricular mais intensa, bem como maior acúmulo de fatores de risco cardiovascular. Trabalho anterior, deste mesmo grupo, mostrou que a hipertrofia ventricular é mais intensa entre renais cônicos de baixa escolaridade. Não há na literatura estudos que avaliem se a maior hipertrofia ventricular possa explicar a maior mortalidade de renais crônicos com baixa escolaridade. Assim, o objetivo do presente estudo é verificar se a hipertrofia ventricular esquerda pode justificar a associação entre escolaridade e mortalidade cardiovascular de renais crônicos em hemodiálise. . Foram avaliados 141 pacientes em hemodiálise no Hospital das Clínicas da Faculdade de Medicina de Botucatu UNESP, que realizaram ecocardiografia no período compreendido entre janeiro de 2005 e março de 2008. Dentre esses pacientes, 28 preencheram algum critério de exclusão. Compuseram a casuística 113 pacientes que foram seguidos até outubro de 2010. Os pacientes foram divididos em dois grupos de acordo com a mediana de anos de escolaridade, ou seja, pacientes com escolaridade inferior a quatro anos e pacientes com escolaridade igual ou superior a quatro anos...
Chronic renal failure is a clinical model of ventricular hypertrophy. Chronic kidney disease is associated with significantly reduced life expectancy. The main cause of death, in this clinical situation, is cardiovascular disease and left ventricular hypertrophy is a potent predictor of cardiovascular events and mortality. Dialysis patients with low education have further reduced life expectancy. This association between low educational level and cardiovascular mortality is well documented in the general population. It was also shown that the less educated have more severe ventricular hypertrophy, as well as greater accumulation of cardiovascular risk factors. Previous work from, this group showed that ventricular hypertrophy is more intense between hemodialysis patients with low education. There are no studies in the literature to assess whether the greater ventricular hypertrophy may explain higher mortality in renal disease patients with low education. Thus, the purpose of this study is to assess whether left ventricular hypertrophy may explain the association between education and cardiovascular mortality in chronic kidney disease. We evaluated 141 hemodialysis patients in Botucatu Medical School Hospital - UNESP, whose echocardiography was performed between January 2005 and March 2008. Among these patients, 28 met some exclusion criteria. The sample comprised 113 patients who were followed until October 2010. Patients were divided into two groups according to the median of schooling, i.e. patients with less than four years of schooling and those with schooling of four or more than four years. We evaluated the clinical, laboratory and echocardiographyc data (left ventricular diameter, posterior wall thickness and interventricular septum, left ventricular mass and left ventricular mass index)...
Asunto(s)
Humanos , Masculino , Femenino , Persona de Mediana Edad , Diálisis Renal/mortalidad , Hipertensión/complicaciones , Hipertensión/mortalidad , Hipertrofia Ventricular Izquierda/mortalidadRESUMEN
A determinação da massa ventricular esquerda tem um grande valor na prática clínica. Pode ser obtida pela ecocardiografia, nas suas diferentes modalidades (uni, bi ou tridimensional), por meio de várias fórmulas e algorítimos matemáticos. Os primeiros estudos utilizaram o modo M e baseavam-se na medida da espessura septal, da parede posterior e da dimensão interna do ventrículo esquerdo, para a realização do cálculo da massa ventricular. Partiam do pressuposto que o ventrículo esquerdo fosse uma esfera. Porém, estudos de necropsia demostraram que essas fórmulas superestimadas a medida da massa ventricular. Por isso, foram aplicados fatores de correção e também verificada a necessidade das medidas pelo método bidimensional, principalmente, em casos de hipertrofia, em que pode existir uma distribuição assimétrica na cavidade ventricular. Novas tecnologias, como a ecocardiografia tridimensional, demonstram uma boa correlação com a ressonância nuclear magnética (RNM), sendo uma ferramenta importante para uma medida mais acurada da massa ventricular.
Asunto(s)
Humanos , Ecocardiografía/métodos , Ecocardiografía , Hipertrofia Ventricular Izquierda/complicaciones , Hipertrofia Ventricular Izquierda/mortalidad , Factores de RiesgoRESUMEN
OBJECTIVES: There is a direct relationship between the regression of left ventricular hypertrophy (LVH) and a decreased risk of mortality. This investigation aimed to describe the effects of anti-hypertensive drugs on cardiac hypertrophy through a meta-analysis of the literature. METHODS: The Medline (via PubMed), Lilacs and Scielo databases were searched using the subject keywords cardiac hypertrophy, antihypertensive and mortality. We aimed to analyze the effect of anti-hypertensive drugs on ventricle hypertrophy. RESULTS: The main drugs we described were enalapril, verapamil, nifedipine, indapamina, losartan, angiotensin-converting enzyme inhibitors and atenolol. These drugs are usually used in follow up programs, however, the studies we investigated used different protocols. Enalapril (angiotensin-converting enzyme inhibitor) and verapamil (Ca(++) channel blocker) caused hypertrophy to regress in LVH rats. The effects of enalapril and nifedipine (Ca(++) channel blocker) were similar. Indapamina (diuretic) had a stronger effect than enalapril, and losartan (angiotensin II receptor type 1 (AT1) receptor antagonist) produced better results than atenolol (selective beta1 receptor antagonist) with respect to LVH regression. CONCLUSION: The anti-hypertensive drugs induced various degrees of hypertrophic regression.
Asunto(s)
Antihipertensivos/uso terapéutico , Hipertrofia Ventricular Izquierda/tratamiento farmacológico , Animales , Humanos , Hipertensión/prevención & control , Hipertrofia Ventricular Izquierda/mortalidad , Ratas , Inducción de Remisión/métodos , Factores de Riesgo , Resultado del TratamientoRESUMEN
OBJECTIVES: The prognostic importance of serial changes in electrocardiographic strain pattern of lateral ST-depression and T-wave inversion is unclear. The objective was to evaluate the significance of baseline and serial changes in strain pattern as predictors of cardiovascular morbidity and mortality in patients with resistant hypertension. METHODS: At baseline and during follow-up, 532 resistant hypertensive patients had the presence of strain pattern examined on 12-lead ECGs. Other clinical laboratory, echocardiographic and ambulatory blood pressure data were obtained. Primary endpoints were a composite of total cardiovascular events and mortality. Strokes and coronary heart disease events were secondary endpoints. Multiple Cox regression assessed the associations between strain pattern and subsequent endpoints. RESULTS: At baseline, 115 patients (21.6%) presented the strain pattern and during follow-up, 17 patients regressed and 22 developed new strain pattern. After a median follow-up of 4.8 years, 69 patients died, 46 from cardiovascular causes; and 107 cardiovascular events occurred, 44 strokes and 42 coronary heart disease events. After adjustment for several cardiovascular risk factors, including time-varying ambulatory blood pressures and electrocardiographic voltage criteria of left ventricular hypertrophy, the persistence or development of strain during follow-up was a predictor of the composite endpoint (hazard ratio 1.97, 95% confidence interval 1.19-3.25), all-cause mortality (hazard ratio 1.99, 95% confidence interval 1.10-3.61) and of stroke (hazard ratio 3.09, 95% confidence interval 1.40-6.81). The combination of strain pattern and left ventricular hypertrophy voltage criteria improved stratification of cardiovascular risk. CONCLUSION: Serial changes in electrocardiographic strain pattern during follow-up predict cardiovascular morbidity and mortality in resistant hypertensive patients. Regression or prevention of the strain pattern during antihypertensive treatment may be a therapeutic goal to improve prognosis.
Asunto(s)
Enfermedad Coronaria/fisiopatología , Ecocardiografía de Estrés , Hipertensión/fisiopatología , Hipertrofia Ventricular Izquierda/fisiopatología , Accidente Cerebrovascular/fisiopatología , Antihipertensivos/uso terapéutico , Presión Sanguínea , Brasil/epidemiología , Enfermedad Coronaria/mortalidad , Progresión de la Enfermedad , Resistencia a Medicamentos , Hipertensión/tratamiento farmacológico , Hipertensión/mortalidad , Hipertrofia Ventricular Izquierda/mortalidad , Pronóstico , Accidente Cerebrovascular/mortalidad , Tasa de SupervivenciaRESUMEN
OBJECTIVES: There is a direct relationship between the regression of left ventricular hypertrophy (LVH) and a decreased risk of mortality. This investigation aimed to describe the effects of anti-hypertensive drugs on cardiac hypertrophy through a meta-analysis of the literature. METHODS: The Medline (via PubMed), Lilacs and Scielo databases were searched using the subject keywords cardiac hypertrophy, antihypertensive and mortality. We aimed to analyze the effect of anti-hypertensive drugs on ventricle hypertrophy. RESULTS: The main drugs we described were enalapril, verapamil, nifedipine, indapamina, losartan, angiotensin-converting enzyme inhibitors and atenolol. These drugs are usually used in follow up programs, however, the studies we investigated used different protocols. Enalapril (angiotensin-converting enzyme inhibitor) and verapamil (Ca++ channel blocker) caused hypertrophy to regress in LVH rats. The effects of enalapril and nifedipine (Ca++ channel blocker) were similar. Indapamina (diuretic) had a stronger effect than enalapril, and losartan (angiotensin II receptor type 1 (AT1) receptor antagonist) produced better results than atenolol (selective â1 receptor antagonist) with respect to LVH regression. CONCLUSION: The anti-hypertensive drugs induced various degrees of hypertrophic regression.
Asunto(s)
Animales , Humanos , Ratas , Antihipertensivos/uso terapéutico , Hipertrofia Ventricular Izquierda/tratamiento farmacológico , Hipertensión/prevención & control , Hipertrofia Ventricular Izquierda/mortalidad , Factores de Riesgo , Inducción de Remisión/métodos , Resultado del TratamientoRESUMEN
OBJETIVO: Avaliar os efeitos do lisinopril (L) sobre as taxas de mortes (M), insuficiência cardíaca (ICC), características da remodelação miocárdica, geométrica e funcional do ventrículo esquerdo (VE), em ratos com estenose aórtica supravalvar (EAS). MÉTODOS: Ratos foram submetidos a EAS ou cirurgia simulada (GC:n=10). Randomizados após 6 semanas para receber L (GL:n=30) ou nenhum tratamento (GE:n=73) sendo avaliados 6s e 21s por estudos ecocardiográfico, hemodinâmico e morfológico concomitantes. RESULTADOS: As taxas de M (GE: 53,9 por cento vs GL: 16,7 por cento e ICC GE: 44,8 por cento vs GL: 20 por cento p<0,05). No final do experimento, os valores da pressão sistólica do VE dos grupos GE e GL foram equivalentes e significantemente mais elevados do que no grupo GC; (p<0,05) não diferindo dos observados 6 semanas após os procedimentos cirúrgicos. Os valores da pressão diastólica do VE no grupo GE foram maiores do que os do grupo GL (p<0,05) sendo ambos maiores do que os do grupo GC (4 ± 2 mmHg, p<0,05). O mesmo comportamento foi observado com as variáveis: razão E/A; índice de massa, área seccional dos miócitos e conteúdo de hidroxiprolina do VE. A porcentagem de encurtamento do VE foi semelhante nos grupos GC e GL (p>0,05) sendo ambos maiores que os verificados no grupo GE. Comportamento semelhante foram obtidos com os valores da primeira derivada positiva e negativa da pressão do VE. CONCLUSAO: Em ratos com EAS o L reduziu as taxas de M e ICC e exerceu efeitos benéficos sobre a remodelação e a função do VE.
Asunto(s)
Ratas , Animales , Masculino , Inhibidores de la Enzima Convertidora de Angiotensina/farmacología , Estenosis Aórtica Supravalvular/fisiopatología , Hipertensión/fisiopatología , Hipertrofia Ventricular Izquierda/patología , Hipertrofia Ventricular Izquierda/fisiopatología , Lisinopril/farmacología , Estenosis Aórtica Supravalvular/complicaciones , Estenosis Aórtica Supravalvular/mortalidad , Gasto Cardíaco Bajo/etiología , Gasto Cardíaco Bajo/mortalidad , Hipertensión/complicaciones , Hipertrofia Ventricular Izquierda/mortalidad , Ratas Wistar , Factores de Tiempo , Función Ventricular Izquierda/efectos de los fármacos , Remodelación Ventricular/efectos de los fármacosRESUMEN
QT-interval parameters are potential indicators of increased cardiovascular risk. We evaluated prospectively their prognostic value, in relation to other risk markers, for cardiovascular fatal and nonfatal events in a cohort of 271 hypertensive type 2 diabetic outpatients. QT intervals were measured from 12-lead standard ECGs obtained on admission and maximum rate-corrected QT-interval duration and QT-interval dispersion (QTd) calculated. Clinical and laboratory data and 2-D echocardiograms (available in 126 patients) were recorded. Survival analyses included Kaplan-Meier survival curves, uni and multivariate Cox proportional-hazards models. After a median follow-up of 55 months (range 2-84), 68 total fatal or nonfatal cardiovascular events and 34 cardiovascular deaths (24 of them from cardiac causes) were observed. In multivariate Cox analysis, QTd was an independent predictor for total cardiovascular events (HR: 1.16, 95% CI: 1.01-1.34, for each 10 ms increments) and for cardiac deaths (HR: 1.28, 95% CI: 1.01-1.60). Other independent risk indicators for cardiovascular morbidity and mortality were echocardiographic left ventricular hypertrophy (Echo-LVH), serum triglycerides, presence of pre-existing cardiac and peripheral arterial disease, age, diabetes duration, heart rate and the presence of frequent ventricular premature contractions on ECG. The combination of QTd and Echo-LVH improved cardiovascular risk stratification compared with either alone, the presence of both prolonged QTd (>65 ms) and Echo-LVH was associated with a 3.2-fold (95% CI: 1.7-6.1) increased risk of a first cardiovascular event and a 5.9-fold (95% CI: 2.1-16.4) increased risk of cardiovascular death. Thus, QT provided additive prognostic information for cardiovascular morbidity and mortality beyond that obtained from conventional risk markers, including Echo-LVH, in type 2 diabetic patients with arterial hypertension.
Asunto(s)
Diabetes Mellitus Tipo 2/complicaciones , Electrocardiografía , Frecuencia Cardíaca/fisiología , Hipertensión/complicaciones , Hipertrofia Ventricular Izquierda/fisiopatología , Adulto , Anciano , Presión Sanguínea/fisiología , Causas de Muerte , Diabetes Mellitus Tipo 2/fisiopatología , Ecocardiografía , Femenino , Estudios de Seguimiento , Ventrículos Cardíacos/diagnóstico por imagen , Ventrículos Cardíacos/fisiopatología , Humanos , Hipertensión/fisiopatología , Hipertrofia Ventricular Izquierda/etiología , Hipertrofia Ventricular Izquierda/mortalidad , Masculino , Persona de Mediana Edad , Pronóstico , Modelos de Riesgos Proporcionales , Estudios Prospectivos , Factores de Riesgo , Tasa de SupervivenciaRESUMEN
OBJECTIVE: To assess left ventricular mass in patients with heart failure and its correlations with other clinical variables and prognosis. METHODS: The study comprised 587 patients aged from 13.8 years to 68.9 years, 461 (78.5%) being males and 126 (21.5%) females. Left ventricular mass was estimated by using M-mode echocardiography and was indexed by height. RESULTS: The left ventricular mass index ranged from 35.3 g/m to 333.5 g/m and increased with age. The left ventricular mass index was greater in males (mean, 175.7 g/m) than in females (mean, 165.7 g/m). The left ventricular mass index was greater in patients with hypertensive cardiomyopathy (mean of 188.1 g/m), with idiopathic dilated cardiomyopathy (mean, 177.7 g/m) and with cardiomyopathies of other etiologies (mean, 175.1 g/m) than in patients with chagasic (mean, 164.3 g/m) or ischemic (mean, 162 g/m) cardiomyopathy. The left ventricular mass index in patients with heart failure showed a correlation with age, sex, etiology, and left atrial diameter. The correlation with left ventricular ejection fraction was negative: the increase in the left ventricular mass index was associated with a reduction in ejection fraction. The relative risk of death was 1.22 for each 50-g/m increase in the left ventricular mass index. CONCLUSIONS: The estimate of left ventricular mass may contribute to the prognostic assessment of patients with heart failure.
Asunto(s)
Insuficiencia Cardíaca/diagnóstico por imagen , Hipertrofia Ventricular Izquierda/diagnóstico por imagen , Adolescente , Adulto , Factores de Edad , Anciano , Pesos y Medidas Corporales , Ecocardiografía , Métodos Epidemiológicos , Femenino , Insuficiencia Cardíaca/fisiopatología , Ventrículos Cardíacos/diagnóstico por imagen , Humanos , Hipertrofia Ventricular Izquierda/mortalidad , Hipertrofia Ventricular Izquierda/fisiopatología , Masculino , Persona de Mediana Edad , Pronóstico , Factores SexualesRESUMEN
OBJETIVO: Avaliar a massa ventricular esquerda em pacientes com insuficiência cardíaca, as correlações com outras variáveis clínicas e com o prognóstico. MÉTODOS: Foram estudados 587 pacientes com idades entre 13,8 anos e 68,9 anos, 461 (78,5 por cento) homens e 126 (21,5 por cento) mulheres. A massa ventricular esquerda foi estimada com o uso do ecocardiograma no modo M e indexada pela altura. RESULTADOS: O índice da massa ventricular esquerda variou de 35,3 g/m a 333,5 g/m e aumentou conforme a idade. O índice da massa ventricular esquerda foi maior nos homens (média 175,7 g/m) do que nas mulheres (média 165,7 g/m). O índice da massa ventricular esquerda foi maior nos portadores de cardiomiopatia hipertensiva (média 188,1 g/m), de cardiomiopatia dilatada idiopática (média 177,7 g/m) e de cardiomiopatias de outras etiologias (média 175,1 g/m) do que nos portadores de cardiomiopatia chagásica (média 164,3 g/m) e isquêmica (média 162 g/m). O índice da massa ventricular esquerda de portadores de insuficiência cardíaca demonstrou associação com a idade, o sexo, a etiologia e o diâmetro do átrio esquerdo. A correlação com a fração de ejeção do ventrículo esquerdo foi negativa - o aumento do índice da massa ventricular esquerda associou-se à redução da fração de ejeção. O risco relativo de óbito foi 1,22 para cada acréscimo de 50 g/m no índice da massa ventricular esquerda. CONCLUSÕES: A estimação da massa ventricular esquerda pode contribuir para a avaliação prognóstica de portadores de insuficiência cardíaca.
Asunto(s)
Humanos , Masculino , Femenino , Adolescente , Adulto , Persona de Mediana Edad , Insuficiencia Cardíaca , Hipertrofia Ventricular Izquierda/diagnóstico , Factores de Edad , Pesos y Medidas Corporales , Ecocardiografía , Métodos Epidemiológicos , Ventrículos Cardíacos , Hipertrofia Ventricular Izquierda/mortalidad , Hipertrofia Ventricular Izquierda/fisiopatología , Pronóstico , Factores SexualesRESUMEN
Se realizó un estudio descriptivo retrospectivo de todos los pacientes a quienes se practicó disección aórtica en un período de 10 años (n = 55) para conocer los factores en el comportamiento de esta entidad y la tendencia de la mortalidad. Se revisaron los expedientes clínicos y los protocolos de necropsia en los que se emitió el diagnóstico anatomopatológico. Se constató predominio del sexo masculino, raza blanca, la edad media de 76,32 años, el antecedente de hipertensión arterial en 63,63 porciento y la hipertrofia ventricular izquierda en 74,54 porciento. Se corroboró que el diagnóstico al ingreso sólo se realizó en el 18,18 porciento y los síntomas fundamentales fueron dolor, disnea y pérdida de la conciencia. Se verificó la rotura en 34 casos y existió una tendencia creciente de la mortalidad. Se expresaron los principales resultados en tablas y se aplicó la media, la desviación estándar y las tasas para el análisis de los resultados (AU)
Asunto(s)
Epidemiología Descriptiva , Estudios Retrospectivos , Hipertensión/complicaciones , Hipertensión/mortalidad , Hipertrofia Ventricular Izquierda/complicaciones , Hipertrofia Ventricular Izquierda/mortalidad , Factores de Riesgo , Disección , Enfermedades de la Aorta/patología , Enfermedades de la Aorta/mortalidadRESUMEN
Se realizó un estudio descriptivo retrospectivo de todos los pacientes a quienes se practicó disección aórtica en un período de 10 años (n = 55) para conocer los factores en el comportamiento de esta entidad y la tendencia de la mortalidad. Se revisaron los expedientes clínicos y los protocolos de necropsia en los que se emitió el diagnóstico anatomopatológico. Se constató predominio del sexo masculino, raza blanca, la edad media de 76,32 años, el antecedente de hipertensión arterial en 63,63 porciento y la hipertrofia ventricular izquierda en 74,54 porciento. Se corroboró que el diagnóstico al ingreso sólo se realizó en el 18,18 porciento y los síntomas fundamentales fueron dolor, disnea y pérdida de la conciencia. Se verificó la rotura en 34 casos y existió una tendencia creciente de la mortalidad. Se expresaron los principales resultados en tablas y se aplicó la media, la desviación estándar y las tasas para el análisis de los resultados
Asunto(s)
Enfermedades de la Aorta/mortalidad , Enfermedades de la Aorta/patología , Disección , Epidemiología Descriptiva , Hipertensión/complicaciones , Hipertensión/mortalidad , Hipertrofia Ventricular Izquierda/complicaciones , Hipertrofia Ventricular Izquierda/mortalidad , Estudios Retrospectivos , Factores de RiesgoRESUMEN
BACKGROUND: Medically refractory heart failure is traditionally managed with cardiac transplantation although some limited success has also been obtained in selected patients using dynamic cardiomyoplasty or mechanical assist devices. Recently, a new surgical alternative called partial left ventriculectomy (PLV) was introduced by Batista in 1995. The procedure attempts to relieve symptoms of congestive failure by reducing myocardial mass and restoring the normal mass-to-volume ratio of the left ventricle. Despite initial enthusiasm, the results of PLV are not yet known. The aim of this study was to determine survival and clinical outcomes in a group of patients submitted to PLV as a means of surgical treatment for end stage heart disease (ESHD) METHODS: From November 1994 to December 1995, 15 patients with ESHD and dilated cardiomyopathy (DCM) were operated on by the technique described by Randas Batista. We compared preoperative and postoperative assessments of NYHA Functional Class (FC), Quality of Life index (QOL), echocardiographic, ergometric, radioisotopic ventriculography and hemodynamic data at intervals of zero, one, three, six and nine, and twelve months postoperatively. Kaplan-Meier, student t-test and chi-square analysis were applied to the numerical and categoric variables. RESULTS: Survival was 80% at one month, 66% at three months, 53% at six months, 47% at nine months and 40% at one year. We also found that 6 of 7 patients (85%) with tricuspid regurgitation (TR) died compared to 4 of 8 patients (50%) without TR. This was the only risk factor indentified which influenced mortality. Post-operative echocardiographic evaluations demonstrated reduced left ventricular end-diastolic and end-systolic diameters at six months (LVESD 65.5 +/- 8.3 mm preoperatively versus 56.83 +/- 5.74 mm at six months, p=0.007 and LVEDD 73.84 +/- 8.25 mm preoperatively versus 65.33 +/- 5.72 mm at six months, p=0.009). Survivors enjoyed an improved clinical status according to both the NYHA functional class (preoperative Class IV=100% versus postoperative at six months : Class IV = 50%, Class III = 17% and Class II = 33%) and the Quality of Life index (100% were in grade 6 and 7 preoperatively versus 0% at six months). However, statistical significance was not reached in most of these data due to the small number of patients. CONCLUSIONS: Actuarial survival in this series of patients was 53% at six months and 40% at twelve months with survivors showing fewer symptoms and clinical events than preoperatively (100% hospitalized preoperatively versus no patient hospitalized at six months). Therefore, the Batista Operation improves the quality of life patients with dilated cardiomyopathy and can possibly be a new means for bridging to cardiac transplantation in severely ill patients who are not likely to survive long enough to recieve a donor heart. Additional improvements in late results will likely be seen after further experience, evolution of the surgical techniques and better patient selection.