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Determinants of survival in patients with congestive cardiomyopathy: quantitative morphologic findings and left
Insights
In congestive cardiomyopathy, left ventricular ejection fraction and systolic pressure predict cardiac death. Myocardial biopsy morphometry did not significantly improve prognostic accuracy in this study.
Area of Science:
- Cardiology
- Pathology
Background:
- Congestive cardiomyopathy presents with reduced left ventricular ejection fraction.
- Prognostic evaluation often relies on hemodynamic and angiographic data.
Purpose of the Study:
- To compare the prognostic significance of quantitative myocardial morphologic findings with left ventricular hemodynamics in patients with congestive cardiomyopathy.
Main Methods:
- Analysis of left ventricular endomyocardial biopsy specimens from 68 patients.
- Light-microscopic morphometry to assess myocardial fiber diameter, interstitial fibrosis, and myofibril content.
- Multivariate regression analysis (Cox model) using clinical, hemodynamic, and morphometric data.
Main Results:
- Left ventricular ejection fraction and systolic pressure were independent predictors of cardiac death.
- Morphometric findings from myocardial biopsy specimens did not significantly predict cardiac death.
- 23 deaths occurred during a mean follow-up of 1124 days.
Conclusions:
- Left ventricular hemodynamics, specifically ejection fraction and systolic pressure, are key prognostic indicators in congestive cardiomyopathy.
- Quantitative morphologic analysis of myocardial biopsy specimens does not add significant prognostic value when hemodynamic data are available.
Abstract:
We analyzed data from 68 consecutive patients with congestive cardiomyopathy to evaluate the prognostic significance of quantitative morphologic findings in left ventricular myocardium as compared with the prognostic significance of left ventricular hemodynamics. Left ventricular endomyocardial biopsy specimens were obtained from all patients during diagnostic heart catheterization. Myocardial fiber diameter, volume fraction of interstitial fibrosis, and intracellular volume fraction of myofibrils were determined by light-microscopic morphometry. All patients had normal coronary arteriograms, but reduced left ventricular ejection fractions. There were 23 deaths during a mean follow-up period of 1124 days. Multivariate regression analysis (Cox model) revealed that left ventricular ejection fraction (p less than .00001) and left ventricular systolic pressure (p less than .01), but not morphometric findings in biopsy specimens, were independent predictors of cardiac death. Thus, morphologic findings in the left ventricular myocardium do not contribute significantly to the prognostic evaluation in patients with congestive cardiomyopathy studied by hemodynamic and angiographic methods.