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Persistence of restrictive left ventricular filling pattern in dilated cardiomyopathy: an ominous prognostic sign
B Pinamonti1, M Zecchin, A Di Lenarda
1Department of Cardiology, University of Trieste, Italy.
Insights
Persistent restrictive left ventricular filling pattern in dilated cardiomyopathy indicates poor prognosis. Reversible patterns predict improvement and survival, highlighting the value of early Doppler echocardiography reevaluation.
Area of Science:
- Cardiology
- Echocardiography
- Heart Failure
Background:
- Restrictive filling pattern (RFP) in dilated cardiomyopathy (DCM) is linked to poor prognosis.
- Limited data exist on the prognostic impact of evolving RFP in DCM patients.
Purpose of the Study:
- To evaluate the prognostic significance of changes in restrictive left ventricular filling patterns in patients with DCM.
- To determine if the evolution of RFP impacts mortality and clinical outcomes.
Main Methods:
- Doppler echocardiography was used to assess left ventricular filling in 110 DCM patients.
- Patients were categorized into persistent restrictive (1A), reversible restrictive (1B), and nonrestrictive (2) filling groups based on 3-month follow-up.
- Outcomes including mortality, heart transplantation, and clinical improvement were tracked over 41 months.
Main Results:
- Group 1A (persistent RFP) had significantly higher mortality and heart transplantation rates compared to Groups 1B and 2 (p < 0.0001).
- E wave deceleration time at 3 months was a stronger predictor of mortality than at baseline (p = 0.0039).
- Clinical improvement was more frequent in Groups 1B and 2 at 1 and 2 years (p < 0.0001 at 2 years).
Conclusions:
- Persistent restrictive filling at 3 months in DCM patients predicts high mortality and transplantation rates.
- Reversible restrictive filling is associated with improved outcomes and survival.
- Serial echocardiographic assessment after 3 months provides crucial prognostic information beyond the initial evaluation.
Objectives:
We sought to assess the prognostic implications of the evolution of restrictive left ventricular filling pattern (RFP) in dilated cardiomyopathy (DCM).
Background:
Previous work has demonstrated that a RFP in DCM is associated with a poor prognosis. Few data are available on the prognostic implications of the evolution of this pattern.
Methods:
The evolution of left ventricular filling was studied by Doppler echocardiography in 110 patients with DCM. According to the left ventricular filling pattern at presentation and after 3 months of treatment, the patients were classified into three groups: Group 1A (n = 24) had persistent restrictive filling; Group 1B (n = 29) had reversible restrictive filling; and Group 2 (n = 57) had nonrestrictive filling.
Results:
During follow-up (41 +/- 20 months), mortality plus heart transplantations was significantly higher in Group 1A than in Groups 1B and 2 (p < 0.0001). On multivariate analysis, the model incorporating E wave deceleration time at 3 months was more powerful at predicting mortality with respect to this variable at baseline (p = 0.0039). Clinical improvement at 1 and 2 years was significantly more frequent in Groups 1B and 2 than in Group 1A (p < 0.0001 at 2 years).
Conclusions:
In patients with DCM, the persistence of restrictive filling at 3 months is associated with a high mortality and transplantation rate. The patients with reversible restrictive filling have a high probability of improvement and excellent survival. Doppler echocardiographic reevaluation of these patients after 3 months of therapy gives additional prognostic information with respect to the initial study.