[Analysis of predictive factors of mortality in dilated cardiomyopathy. A cooperative study by the Cardiomyopathy Working Group]
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M Komajda1, J P Jais, B Goldfarb
1Service de cardiologie, hôpital Pitié-Salpêtrière, Paris.
Insights
Predicting survival in dilated cardiomyopathy patients is possible using clinical factors. A new score identifies high-risk patients, enabling targeted interventions for improved outcomes.
Area of Science:
- Cardiology
- Clinical Medicine
- Heart Failure Research
Background:
- Dilated cardiomyopathy (DCM) is a significant cause of heart failure.
- Identifying prognostic factors is crucial for managing DCM patients.
- Predicting long-term survival in DCM remains a clinical challenge.
Purpose of the Study:
- To identify factors predictive of mortality in patients with dilated cardiomyopathy.
- To develop a quantitative score for stratifying DCM patient prognosis.
- To improve survival prediction for dilated cardiomyopathy patients.
Main Methods:
- Multivariate analysis (Cox's model) of 51 clinical, ECG, echocardiographic, and hemodynamic parameters.
- Analysis of 201 patients with dilated cardiomyopathy over an average follow-up of 57.1 months.
- Calculation of a quantitative score (S) based on key predictive factors.
Main Results:
- 5-year survival probability for the cohort was 77%.
- Key predictors of survival included pulmonary edema, peripheral edema, syncope, symptom duration, left ventricular end-diastolic volume/dimension, and systolic pulmonary artery pressure.
- A score (S) stratified patients into three groups with distinct 5-year survival rates: Group A (90%), Group B (84%), and Group C (53%).
Conclusions:
- Dilated cardiomyopathy patients exhibit relatively long global survival.
- A combination of clinical severity, left ventricular dilatation, pulmonary artery pressure, and symptom duration effectively identifies patients with a poor prognosis.
- The developed score (S) aids in identifying high-risk subgroups within the dilated cardiomyopathy population.
Unlabelled:
An analysis of factors predictive of mortality was undertaken in a group of 201 patients with dilated cardiomyopathy (163 men, 38 women; average age 46 +/- 11 years) using a multivariate analysis (Cox's model) of 51 clinical electrocardiographic, echocardiographic and haemodynamic parameters. The average follow-up period was 57.1 +/- 29.9 months. Fifty-six patients died and the probability of 5-year survival was 77 +/- 3 per cent. The best predictive factor of survival was determined by the combination of the following parameters: presenting symptom: pulmonary oedema, peripheral oedema, syncope; duration of symptoms before inclusion into the study; left ventricular end diastolic volume; left ventricular end diastolic dimension; systolic pulmonary artery pressure. A quantitative score "S" was calculated which enabled identification of 3 subgroups: A (S less than 4.5); B (4.5 less than S less than 6); C (S greater than 6). The probability of 5-year survival was 90 +/- 5 per cent in Group A, 84 +/- 4 per cent in Group B and 53 +/- 7 per cent in Group C.
In Conclusion:
global survival was relatively long in this patient population with dilated cardiomyopathy at different stages of evolution; the combination of factors related to clinical severity, left ventricular dilatation, systolic pulmonary artery pressure and duration of symptoms allows identification of a subgroup of patients with a poor prognosis.