Gupta Ankur, Sharma Prafull, Bahl Ajay
Department of Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
Department of Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
Int J Cardiol. 2016 Oct 15;221:310-3. doi: 10.1016/j.ijcard.2016.07.090. Epub 2016 Jul 5.
Limited data is available regarding prognosis of patients with severe left ventricular (LV) systolic dysfunction and varying LV dimensions. Purpose of this study was to compare outcomes of patients with non-ischemic dilated cardiomyopathy (DCM) with respect to LV size.
145 patients of DCM cohort with LV ejection fraction <35% were divided into 3 groups. Group 1 with normal LV dimensions, group 2 with mild-moderately enlarged left ventricle and group 3 with severely dilated left ventricle. Primary endpoint was composite of all cause mortality and heart failure hospitalizations at end of follow-up.
Forty-four patients (30.3%) with normal LV diastolic diameter (51.9±5.3mm) were included in group 1, 57(39.3%) with mild-moderately enlarged LV (61.4±3.7mm) in group 2 and 44(30.3%) with severely enlarged LV (71.3±7.4mm) in group 3. Mean follow-up was 42.2±31.6months. Primary end point occurred in 4 patients (9.1%) in group 1, 8 patients (14%) in group 2 and 9 patients (20.5%) in group 3, p=0.23 by log-rank test. Hazard ratio for primary endpoint in group 2 as compared to group 1 was 1.71(95% CI, 0.51 to 5.67; p=0.39) and in group 3 as compared to group 1 was 1.61(95% CI, 0.89 to 2.91; p=0.11). Of patients with more than two years of follow-up, 2 of 29 patients(6.9%) died in group 1, 3 of 35 patients(8.6%) in group 2 and 3 of 34 patients(8.8%) died in group 3, p=0.95.
Intermediate term prognosis of patients with severe LVSD and severely dilated left ventricle is good, with outcomes similar to patients with normal or mild-moderately dilated left ventricle.
关于严重左心室（LV）收缩功能障碍且左心室大小各异的患者的预后，可用数据有限。本研究的目的是比较非缺血性扩张型心肌病（DCM）患者不同左心室大小的预后情况。
将145例左心室射血分数<35%的DCM队列患者分为3组。第1组左心室大小正常，第2组左心室轻度至中度扩大，第3组左心室严重扩张。主要终点是随访结束时全因死亡率和心力衰竭住院的综合情况。
第1组纳入44例（30.3%）左心室舒张直径正常（51.9±5.3mm）的患者，第2组纳入57例（39.3%）左心室轻度至中度扩大（61.4±3.7mm）的患者，第3组纳入44例（30.3%）左心室严重扩大（71.3±7.4mm）的患者。平均随访时间为42.2±31.6个月。主要终点事件在第1组4例（9.1%）患者、第2组8例（14%）患者和第3组9例（20.5%）患者中发生，经对数秩检验p=0.23。第2组与第1组相比主要终点的风险比为1.71（95%CI，0.51至5.67；p=0.39），第3组与第1组相比为1.61（95%CI，0.89至2.91；p=0.11）。在随访超过两年的患者中，第1组29例患者中有2例（6.9%）死亡，第2组35例患者中有3例（8.6%）死亡，第3组34例患者中有3例（8.8%）死亡，p=0.95。
严重左心室收缩功能障碍且左心室严重扩张患者的中期预后良好其预后与左心室大小正常或轻度至中度扩张的患者相似。
