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Mode of death in idiopathic dilated cardiomyopathy: a multivariate analysis of prognostic determinants
T Hofmann1, T Meinertz, W Kasper
1Medizinische Klinik III, Albert Ludwigs Universität Freiburg, Federal Republic of Germany.
Insights
Identifying prognostic factors for idiopathic dilated cardiomyopathy patients is crucial. Impaired left ventricular function and atrial fibrillation significantly increase risks for sudden cardiac death and heart failure mortality.
Area of Science:
- Cardiology
- Internal Medicine
Background:
- Idiopathic dilated cardiomyopathy (IDCM) is a significant cause of heart failure and sudden cardiac death.
- Accurate prognostication is essential for managing IDCM patients and stratifying risk.
Purpose of the Study:
- To identify independent prognostic factors for sudden cardiac death (SCD) and death from congestive heart failure (CHF) in patients with IDCM.
- To develop a predictive model for risk stratification in IDCM.
Main Methods:
- Prospective follow-up of 110 IDCM patients for a mean of 53 months.
- Multivariate logistic regression analysis to identify independent predictors of mortality.
- Assessment of factors including left ventricular ejection fraction, cardiac index, ventricular arrhythmias, and atrial rhythm.
Main Results:
- The 4-year incidence of cardiac death was 39%.
- Independent predictors of mortality included left ventricular ejection fraction, cardiac index, ventricular pairs per 24 hours, and atrial rhythm.
- A model incorporating these factors correctly classified 88% of patients regarding their risk for CHF death or SCD.
- Impaired left ventricular function and low ventricular pair counts predicted CHF death.
- Frequent complex ventricular arrhythmias combined with depressed left ventricular function predicted SCD.
- Atrial fibrillation significantly increased the risk of both SCD and CHF death.
Conclusions:
- Left ventricular function, ventricular arrhythmias, and atrial rhythm are key determinants of prognosis in IDCM.
- These factors can be used to identify patients at high risk for sudden cardiac death and death from congestive heart failure.
- Atrial fibrillation is a significant independent risk factor for adverse outcomes in IDCM.
Abstract:
A total of 110 patients with idiopathic dilated cardiomyopathy were followed prospectively for 53 +/- 8 (range 41 to 69) months to determine prognostic factors identifying patients at risk for sudden death or death from congestive heart failure. During the follow-up period 39 patients died, 14 of congestive heart failure and 25 suddenly. The incidence of cardiac death after 1 year was 18%, after 2 years 35%, and after 4 years 39%. Multivariate logistic regression analysis identified four independent prognostic factors: left ventricular ejection fraction, cardiac index, number of ventricular pairs/24 hours, and atrial rhythm (sinus rhythm or atrial fibrillation). With the final model of logistic regression 77 of 88 patients (88%) could be classified correctly as being at risk for death from chronic heart failure or sudden cardiac death. Patients who were likely to die of congestive heart failure were characterized by a markedly impaired left ventricular function (measured in terms of left ventricular ejection fraction, cardiac index, or both) and a low number of pairs/24 hours. The association between frequent complex ventricular arrhythmias and depressed left ventricular function identifies patients who are at risk for sudden death. The presence of atrial fibrillation significantly increases the risk of sudden death and death from congestive heart failure.