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[Prognostic significance of changes in left ventricular diastolic function in follow-up of dilatative cardiomyopathy]
J B Fuchs1, G S Werner, R Schulz
1Georg-August-Universität Göttingen, Zentrum für Innere Medizin und Pulmonologie.
Insights
Idiopathic dilated cardiomyopathy (IDC) patients with shorter early deceleration time (EDT) showed poor prognosis. A longer EDT predicts a favorable outcome for patients with IDC, indicating better survival rates.
Area of Science:
- Cardiology
- Echocardiography
- Heart Failure Research
Background:
- Idiopathic dilated cardiomyopathy (IDC) is a complex heart condition affecting cardiac function.
- Assessing prognostic indicators in IDC is crucial for patient management and treatment strategies.
Purpose of the Study:
- To investigate the correlation between clinical course, cardiac function (systolic and diastolic), and clinical status in IDC patients.
- To identify echocardiographic parameters predicting prognosis in patients with IDC.
Main Methods:
- Retrospective analysis of 39 IDC patients, divided into survivors and non-survivors/transplanted groups.
- Evaluation of Doppler echocardiography parameters including early (VE) and late diastolic peak velocity (VA), VE/VA ratio, and early deceleration time (EDT).
- Comparison of baseline and follow-up data over approximately 3 years.
Main Results:
- No significant differences in baseline clinical symptoms, systolic function (fractional shortening), or most diastolic parameters between groups.
- Significantly shorter baseline EDT in the non-survivor/transplanted group (119 ms vs. 196 ms).
- During follow-up, specific diastolic parameters (VE > 0.8 m/s, VE/VA > 1.6, EDT < 150 ms) predicted poor prognosis in IDC patients.
Conclusions:
- Early deceleration time (EDT) at diagnosis is a significant predictor of prognosis in IDC.
- Specific Doppler echocardiography findings during follow-up, including elevated VE and VE/VA ratio and shortened EDT, are associated with poor outcomes.
- A longer EDT (> 150 ms) indicates a favorable prognosis for survival in IDC patients.
Abstract:
A total of 39 patients with idiopathic dilated cardiomyopathy (IDC) and sinus rhythm were examined for correlations between clinical course, systolic/diastolic cardiac function, and clinical status according to NYHA class (I-IV). Patients were divided in two groups: group 1 included survivors (n = 28, 49 +/- 11 years) and group 2 the nonsurvivors (n = 7) and transplanted patients (n = 4 transplanted; 48 +/- 10 years). Both groups were examined several times, and data at baseline were compared with those of the last examination. The follow-up period was about 3 years (group 1: 41 +/- 22 months, group 2: 24 +/- 13). Baseline conditions were defined at the time when the diagnosis of IDC was established. Diastolic cardiac function was evaluated by Doppler echocardiography parameters of early (VE) and late diastolic peak velocity (VA), the ratio of VE/VA and early deceleration time (EDT). Data for clinical symptoms (NYHA group 1: 2.5 +/- 0.9 vs. group 2: 2.7 +/- 1.3, NS) systolic [fractional shortening (FS) group 1: 0.17 +/- 0.06 vs. group 2: 0.16 +/- 0.06, NS], and diastolic function (VE, VA, VE/VA) showed no differences between the two groups. Only the EDT was significantly shorter in group 2 (group 1: 196 +/- 64 ms vs. group 2: 119 +/- 43 ms, P < 0.001) when diagnosis was established. During the follow-up period there was an improvement in both groups concerning NYNA class (group 1 from 2.5 +/- 0.9 to 1.9 +/- 0.7, P < 0.005; group 2 from 2.7 +/- 1.3 to 2.1 +/- 0.9, NS). There was a nonsignificant deterioration in systolic function in group 2 (FS, from 0.16 +/- 0.06 to 0.15 +/- 0.06, P = 0.07), which contrasted to an improvement in group 1 (from 0.17 +/- 0.06 to 0.20 +/- 0.08, P = 0.06). VE/VA increased in group 2 (from 1.24 to 1.67 +/- 1.21, P = 0.09) essentially due to a significantly increased VE (from 0.66 +/- 0.2 m/s to 0.85 +/- 0.27 m/s, P < 0.05). EDT remained shorter in group 2 (group 1.198 +/- 55 ms vs. 149 +/- 84 ms, P < 0.05). In conclusion, values of VE > 0.8 m/s, VE/VA > 1.6, and EDT < 150 ms during follow-up were predictors of poor prognosis in patients with IDC. Patients with a long EDT (> 150 ms) had a favorable prognosis for survival.