At the end of the study, no change in electrocardiographic and

echocardiographic check details parameters were observed (Tables 1 and ​and2).2). Two patients shifted from a normal heart to the a presymptomatic stage due to a pathological increase in Cardiomyopathic Index, while 2 passed from the presymptomatic stage to the spotty fibrosis stage. None of them presented with overt cardiomyopathy. The data above shown suggest that treatment with deflazacort is able to preserve cardiac function in Duchenne patients. Table 1. Inhibitors,research,lifescience,medical DFZ treatment. ECG parameters. Table 2. DFZ treatment. Echocardiographic parameters. In 2010, on the occasion of the XII ICNMD, we reported the results of a long-term administration (10,8 years on average) of fosinopril and deflazacort in 52 DMD patients aged 18-34,1 years in order to assess whether the early and prolonged administration of both drugs was able to prevent or delay Inhibitors,research,lifescience,medical the onset of an overt dystrophinopathic cardiomyopathy (39). The dosage of fosinopril was 0.3mg/kg b.i.d. continuously. Mean age at the onset of fosinopril administration was 11,4 years (range 6-19). All the patients have been examined at 4-month intervals using a standardised clinical

protocol, including clinical examination, standard and dynamic ECG, M-Mode Inhibitors,research,lifescience,medical and 2D echocardiography, Echo-color- Doppler-cardiography. We considered as the onset of an overt cardiomyopathy a value of ejection fraction, evaluated in 2D echo-cardiography, ≤ 50%. A historical group of 35 DMD patients – drug naïf – served as control. A LVEF Inhibitors,research,lifescience,medical > 50% was observed in 76,9% of DMD treated patients, at a mean age of 23 years, vs 15% of DMD patients of the control group (p < 0,001). On the other hand a LVEF < 50% was observed in 23,1% of DMD treated patients, at a mean age of 19,4 years, vs 85% of the control group, at the same age (p < 0,001). Kaplan-Meyer freedom cardiomyopathy was 70% at the age of 23 years in DMD treated boys vs 15% in the control group. The effects of steroids

and ACEIs on cardiac function in DMD boys have not be recently confirmed (40). Inhibitors,research,lifescience,medical However the study presents several limitations, such as the study design based on physician preference, older boys on combination treatment while younger on steroids alone, too short period of follow up. In conclusion, we can affirm that: Steroids in general and deflazacort in particular, remain the “gold Sitaxentan standard” for the treatment of Duchenne muscular dystrophy (41) as they are able to modify the natural history of DMD. ACE inhibitors alone and/or in association with deflazacort are effective in slowing down the onset and the progression of dystrophinopathic cardiomyopathy. Beta-blockers are useful in DMD cases to reduce heart rate. Cardiological treatment should start very early (5 years of age) in the course of the disease, before the fibrosis is established. Acknowledgements We thank patients and their family.