Circulation, Vol 90, 2772-2779, Copyright © 1994 by American Heart Association
CS Rihal, RA Nishimura, LK Hatle, KR Bailey and AJ Tajik
BACKGROUND: Dilated cardiomyopathy is an important cause of morbidity and
mortality among patients with congestive heart failure. Hemodynamic and
prognostic characterization are critical in guiding selection of medical
and surgical therapies. METHODS AND RESULTS: A cohort of 102 patients with
the clinical diagnosis of dilated cardiomyopathy who underwent
echocardiographic examination between 1986 and 1990 was identified and
followed up through July 1, 1991. Patients with moderate or severe symptoms
had lower indices of systolic function and greater left atrial and right
ventricular dilation. Mitral inflow Doppler signals were characterized by a
restrictive left ventricular filling pattern. In multivariate logistic
regression analysis, deceleration time, ejection fraction, and peak E
velocity were independently associated with symptom status. Over a mean
follow-up of 36 months, 35 patients died. Kaplan-Meier estimated survival
at 1, 2, and 4 years was 84%, 73%, and 61%, respectively, and was
significantly poorer than that of an age- and sex-matched population. The
subgroup with an ejection fraction < 0.25 and deceleration time < 130
milliseconds had a 2-year survival of only 35%. The subgroup with ejection
fraction < 0.25 and deceleration time > 130 milliseconds had an
intermediate 2-year survival of 72%, whereas patients with an ejection
fraction > or = 0.25 had 2-year survivals > or = 95% regardless of
deceleration time. In multivariate analysis, ejection fraction and systolic
blood pressure were independently predictive of subsequent mortality.
Mitral deceleration time was significant in univariate analysis.
CONCLUSIONS: In patients with the clinical diagnosis of dilated
cardiomyopathy, markers of diastolic dysfunction correlated strongly with
congestive symptoms, whereas variables of systolic function were the
strongest predictors of survival. Consideration of both ejection fraction
and deceleration time allowed identification of subgroups with divergent
long-term prognoses.
ARTICLES
Systolic and diastolic dysfunction in patients with clinical diagnosis of dilated cardiomyopathy. Relation to symptoms and prognosis
Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minn.
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