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Echocardiography-derived variables predict outcome in patients with nonischemic dilated cardiomyopathy with or
Rajaa Faris1, Andrew J S Coats, Michael Y Henein
1Department of Clinical Cardiology, National Heart and Lung Institute, The Royal Brompton Hospital, Imperial College School of Science, Technology, and Medicine, London, United Kingdom. rajaa_faris18@hotmail.com
Insights
A restrictive left ventricle filling pattern (RFP) significantly increases mortality risk in dilated cardiomyopathy (DCM) patients. Echocardiography can identify high-risk patients for early intervention.
Area of Science:
- Cardiology
- Echocardiography
- Heart Failure Research
Background:
- Dilated cardiomyopathy (DCM) remains a significant cause of heart failure with high mortality.
- Despite advances, prognostic markers for DCM patients are crucial for risk stratification.
Purpose of the Study:
- To evaluate the prognostic significance of echocardiographic variables in DCM patients.
- To determine the impact of a restrictive left ventricle filling pattern (RFP) on mortality.
Main Methods:
- Retrospective cohort study of 337 DCM patients (1994-1998).
- Analysis of echocardiographic data and patient outcomes.
Main Results:
- 58% of patients exhibited a restrictive left ventricle filling pattern (RFP).
- RFP was associated with a more than threefold increased risk of death (aHR 3.2).
- RFP correlated with specific echocardiographic findings like short isovolumic relaxation time and mitral regurgitation.
Conclusions:
- RFP is a potent independent predictor of mortality in nonischemic DCM.
- Echocardiography can identify high-risk DCM patients requiring early aggressive treatment or transplantation consideration.
Background:
Despite recent therapeutic advances, patients with heart failure caused by dilated cardiomyopathy (DCM) still have high morbidity and mortality rates. In this study, we sought to assess the prognostic value of echocardiographic variables in patients with DCM and to assess the impact of a restrictive left ventricle filling pattern.
Design:
We conducted a retrospective cohort study of 337 patients with DCM, using the Royal Brompton Hospital Echocardiography database for the years 1994 to 1998.
Methods And Results:
There were 337 patients with a mean age of 53 +/- 15 years. One hundred ninety-five patients (58%) had a restrictive left ventricle filling pattern (RFP). There was a total of 74 deaths (22%) during the follow-up period (43 +/- 25 months). RFP more than tripled the risk of death (adjusted hazard ratio 3.2, 95% CI 1.8-5.7, P =.003). RFP is correlated with isovolumic relaxation time, incoordinate wall-motion, amplitude of right ventricular long axis excursion on M-mode echocardiography, and mitral regurgitation.
Conclusion:
RFP is a powerful independent predictor of mortality in patients with nonischemic DCM. The risk associated with RFP is greatest among patients who had short isovolumic relaxation time, mitral regurgitation, incoordinate wall-motion, and depressed amplitude of right ventricular long axis excursion. Thus, echocardiography-derived variables may stratify patients with heart failure with DCM who are at high risk, for whom aggressive medical treatment or heart transplantation should be considered early.