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Prediction of outcome in late-stage cardiomyopathy
T L Kelly1, R Cremo, C Nielsen
1Cardiovascular Section, San Diego Veterans Administration Medical Center, CA 92161.
Insights
Patients with ischemic heart failure have a poorer prognosis. Key survival predictors include coronary artery disease, low systolic blood pressure, congestion, and older age, not ejection fraction.
Area of Science:
- Cardiology
- Internal Medicine
- Clinical Research
Background:
- Dilated heart failure (DHF) encompasses various etiologies, including ischemic heart disease (IHD) and idiopathic dilated cardiomyopathy (IDC).
- Prognostic factors in DHF are crucial for risk stratification and patient management.
- Ejection fraction is a common metric, but its predictive value across different DHF subtypes requires further investigation.
Purpose of the Study:
- To identify predictors of long-term mortality in patients with dilated heart failure.
- To compare the prognostic value of clinical variables between patients with IHD and IDC.
- To evaluate the relationship between ejection fraction and survival in DHF.
Main Methods:
- A cohort of 133 DHF patients (80 with IHD, 53 with IDC) was followed for a mean of 29 months.
- Univariate analysis and Cox proportional hazards models were used to assess associations between clinical variables and survival.
- Predictive models were developed for the overall cohort and subgroups.
Main Results:
- Patients with IHD had a worse prognosis than those with IDC.
- Ejection fraction did not correlate with survival in either the overall group or subgroups.
- Key predictors of mortality in the overall DHF group included underlying coronary artery disease, basal systolic blood pressure < 120 mm Hg, chest radiogram congestion, and age > 64.
- In IHD patients, predictors included blood pressure, congestion, maximal heart rate on treadmill, and left bundle branch block.
- In IDC patients, only systolic blood pressure and symptom score predicted survival.
Conclusions:
- Prognosis in dilated heart failure varies significantly based on etiology, with ischemic heart disease conferring a worse outlook.
- Clinical factors beyond ejection fraction, such as presence of coronary artery disease, hemodynamic status (blood pressure, congestion), and demographic factors, are critical for predicting long-term survival.
- Risk stratification models should be tailored to the underlying cause of dilated heart failure.
Abstract:
One hundred thirty-three patients with dilated heart failure, 80 with coronary artery disease, and 53 with idiopathic dilated cardiomyopathy were followed for a mean of 29 months. Patients with ischemic heart disease had a worse prognosis than those classified as having idiopathic cardiomyopathy. Features from history, physical examination, and diagnostic tests done when patients were referred to our clinic were checked for univariate association with survival and were used in Cox model survival analysis to define risk groups. Neither the overall group nor either subgroup showed a relationship between ejection fraction and survival. The best variables for predicting long-term mortality included underlying coronary artery disease, basal systolic blood pressure of less than 120 mm Hg, presence of congestion on chest radiogram, and age over 64. Other variables did not improve risk prediction in the overall group. Among patients with ischemic heart disease, blood pressure, congestion, maximal heart rate on treadmill test, and the presence of left bundle branch block on the initial electrocardiogram all contributed. Only systolic blood pressure and the symptom score were related to survival in idiopathic cardiomyopathy.