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Determinants of end-stage idiopathic dilated cardiomyopathy: a multivariate analysis of 104 patients
F Romeo1, F Pelliccia, C Cianfrocca
1Department of Cardiology, University of Rome, Italy.
Insights
Idiopathic dilated cardiomyopathy prognosis is determined by hemodynamic factors. Mean right atrial pressure, ejection fraction, and end-systolic volume independently predict cardiac death in patients with this condition.
Area of Science:
- Cardiology
- Pathology
Background:
- Idiopathic dilated cardiomyopathy (IDCMP) is a significant cause of heart failure.
- Accurate prognostic markers are crucial for managing IDCMP patients.
Purpose of the Study:
- To identify independent determinants of long-term prognosis in IDCMP.
- To correlate clinical, electrocardiographic, hemodynamic, and histopathologic features with end-stage disease.
Main Methods:
- Retrospective analysis of 104 IDCMP patients.
- Inclusion of clinical, ECG, hemodynamic, and histopathologic data.
- Survival analysis using univariate and multivariate models.
Main Results:
- Hemodynamic parameters like elevated right atrial pressure, pulmonary artery pressure, and left ventricular pressures were associated with mortality.
- Lower ejection fraction and larger ventricular volumes predicted poor outcomes.
- Multivariate analysis identified mean right atrial pressure, ejection fraction, and end-systolic volume as independent predictors of cardiac death.
Conclusions:
- Cardiac catheterization is essential for risk stratification in IDCMP.
- Hemodynamic and ventricular function assessments are key to identifying high-risk patients.
- Prognostic factors include mean right atrial pressure, ejection fraction, and end-systolic volume.
Abstract:
Our purpose in this study was to investigate the correlation of clinical, electrocardiographic, hemodynamic, and histopathologic features at diagnosis with the long-term prognosis in 104 patients with idiopathic dilated cardiomyopathy to determine which factors are the independent determinants of the end-stage disease. During a mean follow-up of 3.8 +/- 3.5 years, 35 patients (33%) died, 14 (13%) suddenly and 21 (20%) from congestive heart failure. Univariate analysis of survival curves disclosed that clinical and electrocardiographic variables at diagnosis were similar in survivors and non-survivors. On the contrary, patients who subsequently died had higher mean right atrial pressure (p = 0.0001), right ventricular end-diastolic pressure (p = 0.0061), mean pulmonary artery pressure (p = 0.0001), and left ventricular systolic (p = 0.0049) and end-diastolic (p = 0.0021) pressure than survivors. They also exhibited larger left ventricular end-diastolic (p = 0.0046) and end-systolic (p = 0.0027) volumes, lower ejection fraction (p = 0.0001), and a greater proportion had severe mitral regurgitation (p = 0.0095). Univariate analysis of histologic findings collected in a subgroup of patients referred since 1984 revealed a mild degree of myocellular hypertrophy to be associated with a poor prognosis (p = 0.0217). Multivariate analysis selected only mean right atrial pressure (p = 0.0022), ejection fraction (p = 0.0089), and end-systolic volume (p = 0.0265) as independent determinants of cardiac death. Our results suggest that cardiac catheterization is mandatory for risk stratification of patients with idiopathic dilated cardiomyopathy, since it allows the assessment of hemodynamic, angiographic, and histopathologic features helpful in identifying patients with a poor prognosis.