近期扩张型心肌病结局的临床和人口统计学预测因素：IMAC（心肌炎和急性心肌病-2 研究）的结果。
Clinical and demographic predictors of outcomes in recent onset dilated cardiomyopathy: results of the IMAC (Intervention in Myocarditis and Acute Cardiomyopathy)-2 study.
机构信息
Cardiovascular Institute, University of Pittsburgh Medical Center, 200 Lothrop Street, Pittsburgh, PA 15213, USA.
出版信息
J Am Coll Cardiol. 2011 Sep 6;58(11):1112-8. doi: 10.1016/j.jacc.2011.05.033.
OBJECTIVES
We sought to determine clinical and demographic predictors of recovery of left ventricular function for subjects with recent onset cardiomyopathy (ROCM).
BACKGROUND
Although ROCM is a frequent reason for consultation and transplantation referral, its prognosis and natural history on contemporary therapy are unknown.
METHODS
In the multicenter IMAC (Intervention in Myocarditis and Acute Cardiomyopathy)-2 study, subjects with a left ventricular ejection fraction (LVEF) of ≤0.40, fewer than 6 months of symptom duration, and an evaluation consistent with idiopathic dilated cardiomyopathy or myocarditis were enrolled. LVEF was reassessed at 6 months, and subjects were followed up for 4 years. LVEF and event-free survival were compared by race, sex, and clinical phenotype.
RESULTS
The cohort of 373 persons was 38% female and 21% black, with a mean age of 45 ± 14 years. At entry, 91% were receiving angiotensin-converting enzyme inhibitors or angiotensin receptor blockers and 82% were receiving beta-blockers, which increased to 92% and 94% at 6 months. LVEF was 0.24 ± 0.08 at entry and 0.40 ± 0.12 at 6 months (mean increase: 17 ± 13 ejection fraction units). Transplant-free survival at 1, 2, and 4 years was 94%, 92%, and 88%, respectively; survival free of heart failure hospitalization was 88%, 82%, and 78%, respectively. In analyses adjusted for sex, baseline LVEF, and blood pressure, LVEF at 6 months was significantly lower in blacks than in nonblacks (p = 0.02). Left ventricular end-diastolic diameter at presentation was the strongest predictor of LVEF at 6 months (p < 0.0001).
CONCLUSIONS
Outcomes in ROCM are favorable but differ by race. Left ventricular end-diastolic diameter by transthoracic echo at presentation was most predictive of subsequent myocardial recovery. (Genetic Modulation of Left Ventricular Recovery in Recent Onset Cardiomyopathy; NCT00575211).
目的
我们旨在确定近期起病心肌病（ROCM）患者左心室功能恢复的临床和人口统计学预测因素。
背景
尽管 ROCM 是咨询和移植转诊的常见原因，但在当代治疗下，其预后和自然病史尚不清楚。
方法
在多中心 IMAC（心肌炎和急性心肌病）-2 研究中，招募了左心室射血分数（LVEF）≤0.40、症状持续时间少于 6 个月且评估符合特发性扩张型心肌病或心肌炎的患者。在 6 个月时重新评估 LVEF，并对患者进行了 4 年的随访。按种族、性别和临床表型比较 LVEF 和无事件生存率。
结果
373 名患者的队列中，女性占 38%，黑人占 21%，平均年龄为 45±14 岁。入组时，91%的患者接受血管紧张素转换酶抑制剂或血管紧张素受体阻滞剂治疗，82%的患者接受β受体阻滞剂治疗，在 6 个月时分别增加至 92%和 94%。LVEF 在入组时为 0.24±0.08，在 6 个月时为 0.40±0.12（平均增加 17±13 个射血分数单位）。移植无失败生存率在 1、2 和 4 年时分别为 94%、92%和 88%；无心力衰竭住院生存率分别为 88%、82%和 78%。在调整性别、基线 LVEF 和血压后，黑人患者 6 个月时的 LVEF 明显低于非黑人患者（p=0.02）。左心室舒张末期直径在入组时是 6 个月时 LVEF 的最强预测因素（p<0.0001）。
结论
ROCM 的预后良好，但存在种族差异。入院时经胸超声心动图测量的左心室舒张末期直径是预测随后心肌恢复的最有效指标。（左心室恢复的遗传调节在近期起病的心肌病中的作用；NCT00575211）。
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