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Long-term prognosis of patients with mildly dilated cardiomyopathy
Hiroaki Kitaoka1, Yoshihisa Matsumura, Naohito Yamasaki
1Department of Medicine and Geriatrics, Kochi Medical School, Nankoku-shi, Japan.
Insights
Mildly dilated cardiomyopathy (MDCM) patients with impaired hemodynamics and left atrial dilation face a poor prognosis. Careful monitoring is crucial, even with mild left ventricular changes, to predict cardiac events.
Area of Science:
- Cardiology
- Heart Failure Research
Background:
- Mildly dilated cardiomyopathy (MDCM) is characterized by specific left ventricular ejection fraction and volume criteria.
- The long-term prognosis and predictors of adverse events in MDCM patients require further investigation.
Purpose of the Study:
- To investigate the long-term prognosis of patients diagnosed with mildly dilated cardiomyopathy.
- To identify predictors of cardiac events in this patient cohort.
Main Methods:
- A cohort of 21 patients with MDCM was followed for an average of 6.8 years.
- Cardiac events, including heart failure deaths and re-hospitalizations, were recorded.
- Left ventricular dimensions, ejection fraction, fractional shortening, and left atrial size were assessed.
Main Results:
- Nine cardiac events occurred, including five heart failure deaths and two sudden deaths.
- Patients without cardiac events showed significant improvement in left ventricular size and systolic function.
- Left atrial dilation during follow-up was observed in patients who experienced cardiac events.
Conclusions:
- A subset of MDCM patients exhibits impaired hemodynamics and left atrial dilation, indicating a poor prognosis.
- Left ventricular end-diastolic pressure, mean pulmonary artery pressure, and left atrial dimension are significant predictors of adverse outcomes.
- Close monitoring of MDCM patients, particularly those with mild left ventricular dilation but signs of hemodynamic compromise or left atrial changes, is essential.
Abstract:
The long-term prognosis of patients with mildly dilated cardiomyopathy (MDCM) was investigated in 21 patients. MDCM was defined as left ventricular ejection fraction < or = 40% and left ventricular end-diastolic volume < or = 120 ml/m2 by left ventriculography. During a follow-up period of 6.8+/-3.7 years, there were 9 cardiac events (5 heart failure deaths, 2 sudden deaths, and 2 re-hospitalizations for heart failure). Only in the patients without cardiac events was there a significant decrease in left ventricular size (end-diastolic dimension decreased from 58+/-6 mm to 50+/-8 mm, p<0.001) and an improvement in systolic function (fractional shortening increased from 17+/-5% to 26+/-11%, p=0.007). However, left atrial dilation was observed in the patients with an event (from 39+/-5 mm to 43+/-5 mm, p=0.02). Based on proportional hazard analysis, left ventricular end-diastolic pressure and mean pulmonary artery pressure at diagnosis and left atrial dimension at the time of follow-up were significant predictors of poor outcome. A subset of patients with MDCM has impaired hemodynamics at diagnosis, left atrial dilation at follow-up and a poor prognosis, and must be followed carefully even if the left ventricular dilatation is mild.