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[Prognostic factors in dilated cardiomyopathies]
A Hagege1, M Desnos, F Fernandez
1Service de cardiologie, hôpital Boucicaut, Paris.
Insights
Dilated cardiomyopathy significantly impacts survival, with left heart failure markers predicting outcomes. Smokers and those with specific cardiac conditions face higher mortality risks.
Area of Science:
- Cardiology
- Internal Medicine
Context:
- Dilated cardiomyopathy (DCM) is a serious condition affecting heart muscle function.
- Understanding prognostic factors is crucial for managing DCM patients.
Purpose:
- To identify clinical and hemodynamic predictors of long-term survival in patients with dilated cardiomyopathy.
Summary:
- A 29-month follow-up of 116 DCM patients revealed a 10-year actuarial death rate of 60%.
- Key predictors of mortality included advanced NYHA classification, elevated left ventricular end-diastolic pressure, increased end-diastolic volume, reduced ejection fraction, and mitral regurgitation.
- Left bundle branch block and a cardiothoracic index > 0.60 also indicated poorer prognosis, while smoking was associated with increased death rates.
Impact:
- Identifies critical markers for risk stratification in dilated cardiomyopathy.
- Informs clinical decision-making and patient counseling regarding prognosis.
- Highlights the importance of managing heart failure symptoms and lifestyle factors like smoking.
Abstract:
One hundred and sixteen patients (mean age 46 years) with dilated cardiomyopathy documented by haemodynamic investigations and angiography with normal coronary arteriography were followed up for a mean period of 29 +/- 19 months. During that period, 36% of the patients died after a follow-up of 30 +/- 20 months. The actuarial death rates were 15% at 2 years, 45% at 6 years and 60% at 10 years. The main factors predictive of survival at 10 years were the clinical and haemodynamic markers of left heart failure. The death rate was multiplied by 1.6 in patients in stages III or IV of the NYHA classification (83% vs 51%, p less than 0.01), by 2.6 in patients with left ventricular end-diastolic pressure above 15 mmHg (73% vs 29%, p less than 0.01), by 2.2 when the indexed end-diastolic volume rose above 200 ml/m2 (75% vs 35%, p less than 0.01), by 2.2 when the left ventricular ejection fraction was below 40% (75% vs 35%, p less than 0.05) and by 2.6 when angiographic mitral valve regurgitation was present (75% vs 34%, p less than 0.01). The death rate at 9 years was 2.3 times higher in patients with left bundle branch block (72% vs 36%, p less than 0.05). A cardiothoracic index over 0.60 proved to be of poor prognosis at one year (death rate: 19%). While alcoholism played no part in the prognosis, the death rate in smokers was consistently higher than in non smokers (56% vs 32% at 6 years, p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)