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Characterization and Long-Term Prognosis of Patients with Different Phenotypes of Dilated Cardiomyopathy
Shuyuan Zhang1, Shiqi Gao1, Zhuang Tian1
1State Key Laboratory of Complex Severe and Rare Diseases, Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China.
Insights
The left ventricular hypertrabeculation phenotype in dilated cardiomyopathy patients increases early major adverse cardiac events risk. This phenotype may help identify high-risk male patients within the first five years.
Area of Science:
- Cardiology
- Cardiovascular Imaging
- Prognostics
Background:
- Prognosis of dilated cardiomyopathy (DCM) in Chinese populations remains understudied.
- Left ventricular (LV) hypertrabeculation often co-exists with DCM, necessitating prognostic clarification.
Purpose of the Study:
- To determine if LV hypertrabeculation phenotype provides additional prognostic information in DCM patients.
- To assess the impact of LV hypertrabeculation on major adverse cardiac events (MACEs) in DCM.
Main Methods:
- Retrospective analysis of DCM patients (≥18 years) from 2002-2022.
- Comparison of isolated DCM (n=353) versus DCM with LV hypertrabeculation (n=97) based on echocardiography.
- Multivariate Cox regression analysis for MACEs.
Main Results:
- No significant difference in overall MACEs between groups (p=0.19).
- DCM with LV hypertrabeculation showed higher MACEs risk in the first 5 years (aHR: 1.83 [1.21-2.77]).
- Prognostic impact of LV hypertrabeculation attenuated after 5 years; significant sex-DCM subtype interaction (p=0.01).
Conclusions:
- LV hypertrabeculation phenotype is associated with increased early MACEs risk in DCM patients.
- The phenotype may aid in identifying high-risk male DCM patients, particularly within the initial 5 years.
- Further research into sex-specific prognostic factors in DCM is warranted.
Background:
Long-term prognosis of dilated cardiomyopathy (DCM) in the Chinese population is lacking, and the left ventricular (LV) hypertrabeculation phenotype usually overlaps with DCM.
Objectives:
The study aims to investigate whether the presence of the LV hypertrabeculation phenotype confers additional adverse prognostic information for DCM patients.
Methods:
We retrospectively reviewed all DCM patients (≥18 years of age at diagnosis) hospitalized in the Peking Union Medical College Hospital between September 2002 and September 2022. The eligible patients were divided into two groups based on echocardiography at diagnosis: the isolated DCM (n = 353), and DCM with the LV hypertrabeculation phenotype (n = 97). The primary endpoint was major adverse cardiac events (MACEs), and multivariate Cox hazards regression models were used to compare the endpoints between the two groups.
Results:
During a mean follow-up time of 4.6 years, there was no significant difference in the primary endpoint between the isolated DCM and DCM with the LV hypertrabeculation phenotype (p = 0.19). The risk of MACEs in the first 5 years was significantly higher in DCM with the LV hypertrabeculation phenotype than isolated DCM (adjusted HR [95%CI]: 1.83 [1.21-2.77]) and after 5 years the effect of the LV hypertrabeculation phenotype as a prognostic attenuated. Subgroup analysis found a significant interaction for the incidence of MACEs between sex and DCM subtypes (p for interaction = 0.01).
Conclusions:
DCM with LV hypertrabeculation phenotypes had a higher early (first 5 years) risk of MACEs. For males, the presence of LV hypertrabeculation phenotypes might be an important clue for identifying high-risk DCM patients.
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