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[Dilated cardiomyopathy. Multivariate discriminant analysis of main hemodynamic-angiographic indices]
M Zanchetta1, L Pedon, R Carlon
1Divisione di Cardiologia, Ospedale Civile, Cittadella.
Insights
Predicting outcomes in dilated cardiomyopathy is possible using key heart measurements. A new scoring system accurately identifies patients at high risk for heart failure or death, aiding in treatment decisions.
Area of Science:
- Cardiology
- Medical Research
Background:
- Dilated cardiomyopathy (DCM) is a significant cause of heart failure.
- Predicting prognosis in DCM patients is crucial for timely intervention and management.
Purpose of the Study:
- To identify key factors predicting prognosis in patients with dilated cardiomyopathy.
- To develop a predictive model for congestive heart failure and mortality risk in DCM.
Main Methods:
- Invasive hemodynamic and volumetric assessment of 47 DCM patients.
- Univariate and multivariate analyses to determine prognostic factors.
- Development of a predictive equation and scoring system based on mass-to-volume (M/V) and end-systolic stress-to-volume (sigma TS/VTS) ratios.
Main Results:
- Multivariate analysis identified M/V and sigma TS/VTS as the most significant predictors of prognosis.
- A predictive equation (F = 7.41573 M/V + 0.87805 sigma TS/VTS - 10.34571) was developed.
- The derived scoring system correctly classified 98% of patients into mild or severe symptomatic groups.
Conclusions:
- Mass-to-volume index ratio and end-systolic stress-to-volume index ratio are powerful predictors of outcome in dilated cardiomyopathy.
- The developed scoring system accurately predicts the risk of congestive heart failure and death.
- These findings support the use of these parameters for patient stratification and consideration for cardiac transplantation.
Abstract:
The study group consisted of 47 consecutive patients (38 men and 9 women) aged between 16 and 56 years with dilated cardiomyopathy studied invasively between January 1980 and December 1986. Follow-up observation (40 +/- 29 months) showed that 28 patients were mildly symptomatic (group 1) and 19 patients were severely symptomatic (group 2: eight of them died due to intractable congestive heart failure). At univariate analysis, group 2 was characterized by higher pulmonary vascular resistance, larger end-diastolic and end-systolic left ventricular volumes, increased left ventricular mass, lower ratio of mass to volume index, depressed angiographic ejection fraction, lower ratio of end-systolic stress and peak systolic pressure to volume index. Multivariate analysis was used to determine which combination of factors might be a better effective predictor of prognosis in these patients: the most important factors were mass to volume index ratio (M/V) and end-systolic stress to volume index ratio (sigma TS/VTS). An equation was developed that can be applied to the prognosis of patients with dilated cardiomyopathy (F = 7.41573 M/V + 0.87805 sigma TS/VTS - 10.34571). A score system was devised on the basis of the summed-up value of these two parameters. When the patients were assigned (according to the score) to one of the previously mentioned two groups, the classification proved to be correct in 98% of the cases. Thus, these factors can accurately predict the development of congestive heart failure or the risk of death in patients with dilated cardiomyopathy, who are reasonable candidates for cardiac transplantation.