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[Observations of dilated cardiomyopathy with marked clinical improvement]
H Kurozumi1, Y Yokota, H Nomura
1First Department of Internal Medicine, Kobe University School of Medicine.
Insights
Dilated cardiomyopathy (DCM) patients with less cardiac fibrosis and higher end-systolic wall stress show improved cardiac function. This suggests fibrosis and wall stress are key factors in DCM prognosis and recovery.
Area of Science:
- Cardiology
- Pathology
- Medical Research
Background:
- Dilated cardiomyopathy (DCM) typically has a poor prognosis.
- Some DCM patients experience spontaneous improvement in cardiac function.
- Understanding the mechanisms behind DCM improvement is crucial.
Purpose of the Study:
- To investigate the clinical and pathological factors associated with favorable outcomes in DCM patients.
- To compare patients with improved cardiac function, stable disease, and mortality.
Main Methods:
- Retrospective analysis of 54 DCM cases over two years.
- Categorization into improved, unimproved, and deceased groups based on cardiac function metrics (Dd, %FS) and survival.
- Comparison of clinical parameters (e.g., pulmonary capillary pressure) and pathological findings (e.g., % fibrosis, end-systolic wall stress).
Main Results:
- Deceased patients had lower % fractional shortening (%FS) and higher pulmonary capillary pressure (PC) and % fibrosis than the unimproved group.
- The improved group showed higher end-systolic wall stress (WSes) and significantly less % fibrosis compared to the unimproved group.
- No significant differences in Dd, Ds, %FS, Thd, or PC were observed between the improved and unimproved groups.
Conclusions:
- Reduced cardiac fibrosis and increased end-systolic wall stress are associated with improved cardiac function in DCM.
- These factors may play a critical role in the favorable clinical course observed in a subset of DCM patients.
- Further research into these mechanisms could inform novel therapeutic strategies for DCM.
Abstract:
Although the prognosis of dilated cardiomyopathy (DCM) is poor, some patients occasionally follow favorable clinical courses and have significant improvement in cardiac function. To elucidate the mechanism of such improvement, we compared the clinical and pathological findings of 54 cases with DCM, including 12 cases with significant improvement (Dd less than 55 mm, %FS greater than 22%) during two years' follow-up (improved group), 26 without significant improvement (unimproved group), and 16 who died within two years (decreased group). Percent fractional shortening (%FS) in the deceased group was less than that in the unimproved group (12.4 +/- 3.9 vs 17.2 +/- 6.2, p less than 0.01). Pulmonary capillary pressure (PC) and % fibrosis in the deceased group were greater than those in the unimproved group [(22.7 +/- 9.5 vs 11.4 +/- 4.2 mmHg, p less than 0.001), (21.7 +/- 9.9 vs 13.4 +/- 3.6, p less than 0.01)], respectively. Although Dd, Ds, %FS, end-diastolic wall thickness (Thd), and PC in the improved group were not different from those in the unimproved group. End-systolic wall stress (WSes) in the improved group was greater than that in the unimproved group (376 +/- 73 vs 319 +/- 60 g/cm2, p less than 0.02), but % fibrosis was less in the improved group (7.6 +/- 3.4 vs 13.4 +/- 3.6, p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)