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Relation of complex ventricular arrhythmias to presenting features and prognosis in dilated cardiomyopathy
F Pelliccia1, P Gallo, C Cianfrocca
1Department of Cardiology, University La Sapienza, Rome, Italy.
Insights
Complex ventricular arrhythmias in dilated cardiomyopathy indicate poor prognosis and are linked to right heart dysfunction and fibrosis. These arrhythmias identify patients at high risk for mortality.
Area of Science:
- Cardiology
- Internal Medicine
- Pathology
Background:
- Dilated cardiomyopathy (DCM) is a significant cause of heart failure.
- Ventricular arrhythmias are common in DCM but their prognostic implications require further clarification.
Purpose of the Study:
- To investigate the relationship between complex ventricular arrhythmias (CVAs) and presenting features, cardiac function, and prognosis in patients with DCM.
Main Methods:
- A cohort of 104 DCM patients (1977-1987) was analyzed.
- Presenting clinical features, hemodynamic data (right atrial and right ventricular pressures), and left ventricular histology were assessed.
- Long-term mortality was evaluated in relation to the presence of CVAs.
Main Results:
- Patients with CVAs (18%) presented with more palpitations, severe dyspnea, and atrial fibrillation.
- CVAs were associated with elevated right atrial and right ventricular end-diastolic pressures, indicating right heart impairment.
- Histological analysis revealed a higher incidence of severe interstitial fibrosis in the left ventricle of patients with CVAs.
- Mortality was significantly higher in patients with CVAs (58%) compared to those without (28%).
Conclusions:
- Complex ventricular arrhythmias in DCM are associated with right heart dysfunction and left ventricular interstitial fibrosis, not left ventricular dysfunction.
- The presence of CVAs is a significant predictor of increased mortality in dilated cardiomyopathy.
Abstract:
To evaluate whether complex ventricular arrhythmias relate to presenting features and prognosis of dilated cardiomyopathy, 104 patients were studied from 1977 to 1987. At diagnosis, the 19 patients with complex ventricular arrhythmias (18%), as compared to the 85 patients without (82%), had a higher incidence of palpitation (P less than 0.01), severe dyspnea (P less than 0.001) and atrial fibrillation (P less than 0.01). They showed also higher mean right atrial pressures (10 +/- 5 vs 6 +/- 4 mm Hg, P less than 0.001) and higher right ventricular end-diastolic pressures (11 +/- 4 vs. 7 +/- 4 mm Hg, P less than 0.001) than patients without complex ventricular arrhythmias. Histologic samples were collected from the 32 patients (31%) studied since 1984 and semiquantitatively graded. The 11 patients with complex ventricular arrhythmias showed a higher frequency of severe interstitial fibrosis than the 21 patients without (64% vs. 24%, P less than 0.05), but they were otherwise similar as to the frequency of marked myocellular hypertrophy, changes of myocardial regression, endocardial fibrosis, attenuation of myocytes, hyperplasia of smooth muscle cells and infiltration by inflammatory cells. During a follow-up of 3.8 +/- 3.5 years, 35 patients (34%) died. Mortality was 58% (11 out of 19) in patients with complex ventricular arrhythmias and 28% (24 out of 85) in patients without (P less than 0.025). These results show that complex ventricular arrhythmias in dilated cardiomyopathy are associated with impairment of function of the right heart and severe interstitial fibrosis of the left ventricle, rather than with left ventricular dysfunction. Presence of complex ventricular arrhythmias also seems to identify those at high risk for death.