Circulation, Vol 71, 1095-1104, Copyright © 1985 by American Heart Association
HR Figulla, G Rahlf, M Nieger, H Luig and H Kreuzer
The hemodynamic courses of 56 patients with congestive cardiomyopathy (CCM)
were investigated. Fourteen patients died within 24 months after diagnosis.
The hemodynamic courses of the remaining 42 patients were investigated in
subsequent examinations by determination of left ventricular ejection
fraction (LVEF), mean pulmonary arterial pressure at maximal workload, and
peak systolic pressure/end-systolic volume index. During the study interval
of 32.2 +/- 20.0 months the conditions of 20 patients (48%) deteriorated,
according to their hemodynamic status, and at least five of these died of
terminal heart failure. Surprisingly, the conditions of 22 patients (52%)
improved or stabilized. One of these died of leukemia. Seven patients in
the latter group with initial LVEFs of 0.30 or less experienced an average
increase from 0.22 to 0.51. Retrospectively consideration of age, alcohol
intake, exercise capacity, and hemodynamic status were not helpful in
predicting the course of the disease. In 38 patients endomyocardial biopsy
samples could be obtained at the time of diagnosis. Reduced myofibril
volume fraction (less than 60%) had prognostic significance for both
hemodynamic deterioration and death (sensitivity 23/24 = 96%), while 14 of
15 patients whose conditions improved or stabilized had a myofibril volume
fraction of 60% or more (specificity 14/15 or 93%, p less than .002). A
relationship between hemodynamic status and the myofibril volume fraction
could not be found. Individual patients with CCM differ significantly with
respect to course of the disease. A distinct separation of the patients by
means of morphologic criteria is possible. This makes it more likely that
the pathogenesis of the disease is not unique.
ARTICLES
Spontaneous hemodynamic improvement or stabilization and associated biopsy findings in patients with congestive cardiomyopathy
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