Komajda M, Jais J P, Goldfarb B, Bouhour J B, Juillières Y, Lanfranchi J, Peycelon P, Geslin P, Carrie D, Grosgogeat Y
Service de cardiologie, hôpital Pitié-Salpêtrière, Paris.
Arch Mal Coeur Vaiss. 1990 Jun;83(7):899-906.
An analysis of factors predictive of mortality was undertaken in a group of 201 patients with dilated cardiomyopathy (163 men, 38 women; average age 46 +/- 11 years) using a multivariate analysis (Cox's model) of 51 clinical electrocardiographic, echocardiographic and haemodynamic parameters. The average follow-up period was 57.1 +/- 29.9 months. Fifty-six patients died and the probability of 5-year survival was 77 +/- 3 per cent. The best predictive factor of survival was determined by the combination of the following parameters: presenting symptom: pulmonary oedema, peripheral oedema, syncope; duration of symptoms before inclusion into the study; left ventricular end diastolic volume; left ventricular end diastolic dimension; systolic pulmonary artery pressure. A quantitative score "S" was calculated which enabled identification of 3 subgroups: A (S less than 4.5); B (4.5 less than S less than 6); C (S greater than 6). The probability of 5-year survival was 90 +/- 5 per cent in Group A, 84 +/- 4 per cent in Group B and 53 +/- 7 per cent in Group C.
global survival was relatively long in this patient population with dilated cardiomyopathy at different stages of evolution; the combination of factors related to clinical severity, left ventricular dilatation, systolic pulmonary artery pressure and duration of symptoms allows identification of a subgroup of patients with a poor prognosis.
对一组201例扩张型心肌病患者（163例男性，38例女性；平均年龄46±11岁）进行了死亡率预测因素分析，采用多变量分析（Cox模型），涉及51项临床、心电图、超声心动图和血流动力学参数。平均随访期为57.1±29.9个月。56例患者死亡，5年生存率为77±3%。生存的最佳预测因素由以下参数组合确定：出现的症状：肺水肿、外周水肿、晕厥；纳入研究前的症状持续时间；左心室舒张末期容积；左心室舒张末期内径；收缩期肺动脉压。计算了一个定量评分“S”，可识别出3个亚组：A组（S＜4.5）；B组（4.5＜S＜6）；C组（S＞6）。A组5年生存率为90±5%，B组为84±4%，C组为53±7%。
在这组处于不同演变阶段的扩张型心肌病患者中，总体生存时间相对较长；与临床严重程度、左心室扩张、收缩期肺动脉压和症状持续时间相关的因素组合可识别出预后不良的患者亚组。
