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[The prognostic indicators of a favorable clinical evolution in dilated cardiomyopathy]
L La Vecchia1, F Bedogni, R Ometto
1Divisione Clinicizzata di Cardiologia, ULSS N 8, Vicenza.
Insights
Predictors of improved outcomes in dilated cardiomyopathy (DCM) were identified. Lower systemic vascular resistance and high alcohol intake were associated with better cardiac function and clinical status in DCM patients.
Area of Science:
- Cardiology
- Internal Medicine
Background:
- Dilated cardiomyopathy (DCM) can improve in some patients, but clear predictors of a favorable outcome are lacking.
- Understanding prognostic factors is crucial for managing DCM patients effectively.
Purpose of the Study:
- To identify predictors of improved cardiac function and clinical status in patients with dilated cardiomyopathy.
- To assess the prognostic value of clinical, hemodynamic, and morphometric data in DCM.
Main Methods:
- A cohort of 33 DCM patients underwent comprehensive non-invasive and invasive diagnostics, including endomyocardial biopsy.
- Patients were followed for a mean of 23 months, with outcomes assessed by clinical status (NYHA class) and cardiac function (ejection fraction).
- Clinical, hemodynamic, and morphometric data were compared between patients with improved outcomes and those who stabilized or deteriorated.
Main Results:
- 13 patients (39%) showed significant improvement in clinical status and cardiac function.
- Lower systemic vascular resistance (p=0.025) and higher alcohol intake (>80 g/day, p=0.03) were significantly associated with improvement.
- Discriminant analysis using these factors achieved 72% predictive power, though 28% of prognoses remained uncertain.
Conclusions:
- Relatively simple clinical and hemodynamic data, particularly systemic vascular resistance and alcohol consumption, can help assess prognosis in DCM.
- High alcohol intake is clinically relevant, as abstention is linked to favorable outcomes.
- Morphometric analysis of endomyocardial biopsies did not provide significant prognostic information.
Abstract:
Improvement in cardiac function and clinical status has been described in subgroups of patients with dilated cardiomyopathy (DCM), but predictors of favourable outcome have not been unequivocally established. In 33 patients with DCM followed up for a mean of 23 months (range 3-68) a full non-invasive and invasive diagnostic work-up, including endomyocardial biopsy, was performed. At the end of the follow-up, 13 patients (39%; Group A) showed a significant improvement in their clinical status (> or = 1 gain in NYHA functional class) and cardiac function (> 0.10 increase in echocardiographic ejection fraction), while 20 (61%; Group B) either stabilized or deteriorated (5 died and 4 underwent successful heart transplantation). Clinical, hemodynamic and morphometric data of the 2 groups were compared. Only lower systemic vascular resistance (Group A 2,836 +/- 637 versus Group B 3,637 +/- 1113; p = 0.025) and higher prevalence of alcohol intake > 80 g/day (Group A 85% versus Group B 40%; p = 0.03) were significantly associated with improvement. Discriminant analysis utilizing these 2 variables along with cardiac index, mitral regurgitation, pulmonary resistance and cardiothoracic ratio reached a discriminant power of 72% (p = 0.0014). The above results suggest that, in our series, relatively simple data provide the most accurate assessment of prognosis. Yet, prediction of favourable versus unfavourable outcome remains uncertain, since an incorrect prognosis will be made in 28% of cases. Morphometric analysis of endomyocardial bioptic specimens does not provide significant prognostic information. The identification of a high alcohol intake has a clinical relevance, since abstention from alcoholic beverages is significantly associated with a favourable outcome in our patients.