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Spontaneous hemodynamic improvement or stabilization and associated biopsy findings in patients with congestive
Insights
Congestive cardiomyopathy (CCM) patient outcomes vary significantly. Myofibril volume fraction on endomyocardial biopsy can predict disease course and prognosis in CCM patients.
Area of Science:
- Cardiology
- Pathology
Background:
- Congestive cardiomyopathy (CCM) is a complex heart condition with variable patient outcomes.
- Predicting the clinical course and prognosis of CCM remains a challenge.
Purpose of the Study:
- To investigate the hemodynamic courses of patients with congestive cardiomyopathy.
- To identify factors, including endomyocardial biopsy findings, that predict disease progression or improvement.
Main Methods:
- Hemodynamic parameters including left ventricular ejection fraction (LVEF) and pulmonary pressures were monitored in 56 CCM patients.
- Endomyocardial biopsies were analyzed for myofibril volume fraction in 38 patients.
- Patient outcomes (death, deterioration, stabilization, improvement) were tracked over a mean of 32.2 months.
Main Results:
- 48% of patients experienced hemodynamic deterioration, with 5 deaths from heart failure within 24 months.
- 52% of patients showed improvement or stabilization of their condition.
- Reduced myofibril volume fraction (<60%) was highly predictive of deterioration and death (96% sensitivity).
- Higher myofibril volume fraction (≥60%) predicted improvement or stabilization (93% specificity).
Conclusions:
- Individual CCM patient courses differ significantly.
- Myofibril volume fraction from endomyocardial biopsy provides significant prognostic information.
- Morphological criteria, like myofibril volume fraction, can distinguish patient groups, suggesting diverse CCM pathogenesis.
Abstract:
The hemodynamic courses of 56 patients with congestive cardiomyopathy (CCM) were investigated. Fourteen patients died within 24 months after diagnosis. The hemodynamic courses of the remaining 42 patients were investigated in subsequent examinations by determination of left ventricular ejection fraction (LVEF), mean pulmonary arterial pressure at maximal workload, and peak systolic pressure/end-systolic volume index. During the study interval of 32.2 +/- 20.0 months the conditions of 20 patients (48%) deteriorated, according to their hemodynamic status, and at least five of these died of terminal heart failure. Surprisingly, the conditions of 22 patients (52%) improved or stabilized. One of these died of leukemia. Seven patients in the latter group with initial LVEFs of 0.30 or less experienced an average increase from 0.22 to 0.51. Retrospectively consideration of age, alcohol intake, exercise capacity, and hemodynamic status were not helpful in predicting the course of the disease. In 38 patients endomyocardial biopsy samples could be obtained at the time of diagnosis. Reduced myofibril volume fraction (less than 60%) had prognostic significance for both hemodynamic deterioration and death (sensitivity 23/24 = 96%), while 14 of 15 patients whose conditions improved or stabilized had a myofibril volume fraction of 60% or more (specificity 14/15 or 93%, p less than .002). A relationship between hemodynamic status and the myofibril volume fraction could not be found. Individual patients with CCM differ significantly with respect to course of the disease. A distinct separation of the patients by means of morphologic criteria is possible. This makes it more likely that the pathogenesis of the disease is not unique.