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Timing of cardiac transplantation in idiopathic dilated cardiomyopathy
Insights
Radionuclide-determined ejection fraction is a key predictor of survival in dilated cardiomyopathy patients awaiting heart transplant. Lower ejection fraction indicates a poorer prognosis, guiding timely transplantation decisions.
Area of Science:
- Cardiology
- Transplant Surgery
Background:
- Idiopathic dilated cardiomyopathy (IDCM) significantly impacts survival and heart transplant candidacy.
- Accurate prognostic markers are crucial for managing IDCM patients and optimizing transplant timing.
Purpose of the Study:
- To identify variables predicting survival duration in IDCM patients assessed for cardiac transplantation.
- To evaluate the prognostic value of left ventricular ejection fraction (LVEF) determined by radionuclide study.
Main Methods:
- Seventy-nine IDCM patients (excluding ischemic, alcoholic, peripartum cardiomyopathy) were followed for 18 months.
- Assessed variables included LVEF (radionuclide, echocardiography), cardiac catheterization, and myocardial biopsy.
- Statistical analyses included multivariant and Cox regression models.
Main Results:
- Radionuclide-determined LVEF was the sole significant predictor of mortality (r=0.38, p<0.05).
- LVEF accurately predicted survival to 3 months (p<0.0001) and 6 months (p<0.05).
- Patients with LVEF ≥0.20 had no deaths within 6 months; LVEF ≤0.10 predicted extremely poor prognosis (17% 6-month survival).
Conclusions:
- Radionuclide-determined LVEF is a powerful prognostic indicator in IDCM patients awaiting transplant.
- Transplantation within 6-12 months is suggested for patients with LVEF 0.11-0.19.
- IDCM patients with LVEF ≤0.10 require urgent transplantation due to dire prognosis.
Abstract:
Seventy-nine patients with idiopathic dilated cardiomyopathy were assessed and followed up to evaluate 9 variables that might predict duration of survival after assessment for cardiac transplantation. Patients with ischemic heart disease, alcoholic and peripartum cardiomyopathy were excluded. There were 38 deaths (48%) during the 18-month (mean) follow-up. Patients underwent determination of left ventricular ejection fraction by radionuclide scan, echocardiography, cardiac catheterization and myocardial biopsy. Only left ventricular ejection fraction determined by radionuclide study correlated significantly with time to death in nonsurvivors (r = 0.38, p less than 0.05). Multivariant analysis and Cox multivariate regression analysis revealed that the single consistent determinant of prognosis was radionuclide-determined ejection fraction. It was an excellent predictor of survival to 3 months (p less than 0.0001) and a reasonable predictor of survival to 6 months (p less than 0.05). There was no variable that efficiently predicted survival for any period greater than 6 months. In 15 of 70 patients (21% of the entire group), clinical status and radionuclide ejection fraction improved after assessment but only one of these had an ejection fraction less than or equal to 0.10. No patient with a radionuclide ejection fraction greater than or equal to 0.20 died within 6 months of assessment. For those with ejection fraction between 0.11 and 0.19, survival after cardiac transplantation exceeded that of the natural history of their disease; this suggests that transplantation should be undertaken within 6 to 12 months of assessment. Left ventricular ejection fraction less than or equal to 0.10 predicts an extremely poor prognosis (6-month survival was 17%) and such patients should be transplanted with minimal delay.