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Long-term outcome and prognostic factors in dilated cardiomyopathy. Preliminary results
F M Fruhwald1, J Dusleag, B Eber
1Department of Internal Medicine, Karl-Franzens-University, Graz, Austria.
Insights
Time to diagnosis, left ventricular ejection fraction (LVEF), and left ventricular end-diastolic pressure (LVEDP) are key indicators for dilated cardiomyopathy (DCM) prognosis. Early diagnosis and improved LVEF are linked to better patient outcomes in DCM.
Area of Science:
- Cardiology
- Internal Medicine
Background:
- Dilated cardiomyopathy (DCM) is a significant cause of heart failure.
- Long-term prognostic factors in DCM patients require further investigation.
Purpose of the Study:
- To conduct a long-term follow-up of patients with dilated cardiomyopathy.
- To identify prognostic factors influencing patient outcomes in DCM.
Main Methods:
- 167 consecutive DCM patients underwent outpatient evaluation.
- Left- and right-heart catheterization was performed on all patients.
- Follow-up included clinical and echocardiographic assessments.
Main Results:
- After a mean follow-up of 93 months, 49% of patients survived.
- Patients who died had significantly lower LVEF (32%) and higher LVEDP (22 mmHg) at diagnosis compared to survivors.
- Median time from symptom onset to diagnosis was significantly longer in non-survivors (24 months) than in survivors (2-3 months).
Conclusions:
- Time to diagnosis, LVEF, and LVEDP are significant prognostic indicators in DCM.
- Etiology, medical treatment, and NYHA functional classification did not show significant differences between outcome groups.
Unlabelled:
To investigate long-term follow-up and identify prognostic factors in patients with dilated cardiomyopathy (DCM) the authors investigated 167 consecutive patients on an outpatient basis. All patients underwent left- and right-heart catheterization; follow-up comprised clinical and echocardiographic investigations.
Results:
After a mean follow-up period of ninety-three +/- thirty-six months 82 patients (49%; 71 men, 11 women, mean age fifty-five +/- eleven years) were alive. 29 of them (27 men, 2 women, mean age fifty-two +/- nine) showed normal left ventricular ejection fraction (LVEF) after a mean follow-up period of one hundred four +/- forty months. The remaining 53 patients (44 men, 9 women, mean age fifty-six +/- eleven) revealed LVEF similar to that of the first examination. Eighty-five patients died (51%; 73 men, 12 women). Causes of death were the following: progressive heart failure, 24; sudden death, 23; stroke, 3; pulmonary embolism, 2; noncardiac death, 4; unknown causes, 29. The median period from the onset of first symptoms until definite diagnosis was two months in patients with stable conditions, three months in those with normalization of LVEF and twenty-four months in those who died, respectively (P < 0.01). At the time of diagnosis, patients with stable outcome had a mean LVEF (LVEF 1) of 37%, those who returned to normal had 40% (ns). Patients who died had a mean LVEF 1 of 32% and therefore differed significantly from both groups of survivors (P < 0.001). Left ventricular end-diastolic pressure (LVEDP) at the time of diagnosis was highest in patients who died (22 mmHg) and therefore differed significantly from both groups of survivors (normalization: 16 mmHg, stable patients: 18 mmHg, P < 0.001).
Conclusions:
According to their results, time until diagnosis, LVEF, and LVEDP are prognostic indicators. No difference was noted between the groups concerning etiology, medical treatment, or functional classification according to the New York Heart Association.