Brief Answer:
I would explain as follows:

Detailed Answer:

Hello!

Welcome back on HCM!

I understand your concern and would like to explain that as your mother is suffering from dilated cardiomyopathy and severe heart failure actually she has received an appropriate therapy by CRT-ICD implantation and an optimal drugs therapy (after reviewing the attached reports).

Improvements in LVEF has occurred after this combined therapy, and it is necessary to carefully follow up by repeated cardiac ultrasound for monitoring further potential reverse re-modelling and thus EF improvements.

What is concerning is her important mitral regurgitation which may impede a positive remodelling and EF increase.

Coming to this point I would say that her actual clinical status is the most important determinant of further steps on the management strategy.

A surgical correction of mitral regurgitation (which seems to be secondary to LV dilatation) would not be much preferred facing her decreased cardiac function and the increased surgical risks.

Probably a percutaneous edge-to-edge repair may be considered as a tentative to improve symptoms, but no evidence to improve survival exists.

Other options are mechanical circulatory support devices, which are considered in patients in end stage heart failure despite the optimal medical therapy, in order to improve symptoms, reduce hospitalizations and the risk of premature death.

These devices may be used as a bridge to heart transplantation or even as a destination therapy. But when considering such an option several variables should be taking into account (like comorbidities, overall functional status, peripheral arterial or cerebro-vascular diseases, acute infections, etc).

All the above alternative strategies will depend on the opportunity of the attending medical center for offering the assistance.

Hope to have been helpful to you!

In case of further uncertainties do not hesitate to contact me!

Best regards,

Dr. Iliri

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Brief Answer:
My opinion:

Detailed Answer:

Hi again, xxxxxx!

I would like to explain that EECP therapy doesn't seem to be beneficial for your mother, as she actually has a very dilated left ventricle with irreversible remodelling changes, and no clear clinical symptomatology for refractory angina.

The most appropriate strategy for your mother would be circulatory support devices and possibly valvular and left ventricular myocardial reconstruction (but this latter may be achieved in very few specialized surgical centers).

Of course an optimal drugs therapy is a major therapeutic cornerstone of medical management.

Best wishes,

Dr. Iliri

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