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[Follow-up of patients with minor grades of dilated cardiomyopathy]
Insights
Mild dilated cardiomyopathy (DCM) with slight left ventricular contraction reduction rarely progresses. This study suggests it may not always be an early form of DCM, offering new insights for patient management.
Area of Science:
- Cardiology
- Cardiovascular Imaging
- Heart Failure Research
Context:
- Dilated cardiomyopathy (DCM) classification remains debated, particularly for mild cases.
- The prognostic significance of slight reductions in left ventricular ejection fraction is unclear.
- Understanding early DCM progression is crucial for timely intervention.
Purpose:
- To investigate the long-term clinical and echocardiographic progression of mild DCM.
- To determine if mild DCM with reduced left ventricular contractions represents an early, deteriorating form of the disease.
- To assess the stability of cardiac function over time in this patient cohort.
Summary:
- This prospective study followed 29 patients with mild DCM (ejection fraction 50-60%) for approximately 4 years.
- No significant changes were observed in clinical class, cardiac dimensions, or M-mode fractional shortening.
- While 2D echocardiography showed a slight decrease in ejection fraction, overall deterioration was rare, with only one patient showing significant decline.
Impact:
- Findings suggest that mild DCM with mildly reduced contractions may be a stable condition, not necessarily an early stage of progressive disease.
- Challenges the assumption that all mild DCM cases will inevitably worsen.
- Informs clinical practice regarding the monitoring and classification of mild dilated cardiomyopathy.
Abstract:
It is not known whether dilated cardiomyopathy (DCM) with a slight reduction of left ventricular contractions represents an "early form" and is liable to deterioration. 29 patients (mean age 45 +/- 10 years; 66% women) with mild DCM (angiographic ejection fraction between 50 and 60%, mean 56 +/- 3%) were prospectively studied for 4.0 +/- 1.7 years. No patients died. Comparing the beginning of this study (I) with its end (II) the mean clinical class (I 2.0 +/- 0.4, II 2.0 +/- 0.4), cardio-thoracic ratio (I 0.48 +/- 0.05, II 0.47 +/- 0.04), the end-diastolic diameter of the left ventricle (I 52.2 +/- 6.2 mm, II 53.0 +/- 5.2 mm) and fractional shortening in M-Mode echocardiography (I 28.3 +/- 6.8%, II 29.4 +/- 7.1%) remained unchanged. Compared to the angiographic ejection fraction at the start of the study, this parameter was slightly reduced in the final examination by 2-dimensional echocardiography (46 +/- 7%). One patient with definite echocardiographic and clinical deterioration showed from the outset a distinct increase in end-diastolic size of the left ventricle. Four patients with improvement in M-Mode parameters did not fundamentally differ from the rest of the patients. Our results indicate that a slight reduction in contractions rarely deteriorates further, and should thus not always be considered as an early form of DCM.