Balije Swetha, Kumar Ashutosh, Bhawani Goru, Murthy Kasturi S N, Kumari Neera
GSL Medical College & Hospital, Rajahmundry, India.
Department of Cardiology, Narayana Medical College, Nellore, India.
Indian J Med Res. 2016 Aug;144(2):281-287. doi: 10.4103/0971-5916.195045.
BACKGROUND & OBJECTIVES: Dilated cardiomyopathy (DCM) is a progressive disease of heart with systolic and diastolic dysfunction carrying a poor long-term prognosis. The prognostic index and predictors of mortality are considered to be useful in guiding the treatment. This study was undertaken to evaluate the effects of hypertension at presentation on prognosis in patients with DCM presenting with normal renal and coronary angiogram.
An observational, analytical, non-interventional and a combination of retrospective and prospective study was conducted in patients between 15 and 75 yr of age with DCM having on and off symptoms while receiving treatment in a cardiology outpatient department for more than a year. Sixty patients who fulfilled the inclusion criteria were enrolled in the study. Left ventricular systolic and diastolic functions were assessed by echocardiography along with New York Heart Association (NYHA) functional class prospectively and at baseline retrospectively. Patients were grouped into two categories: DCM with hypertension at presentation (HTNAP, Category 1) and DCM without hypertension at presentation (NHTNAP, Category 2). The primary end-points were the number and dose of parenteral drugs at hospitalization, duration of hospital stay and change in the left ventricular (LV) systolic function expressed as LV ejection fraction, and the secondary end-points included overall mortality, change in LV and right ventricular systolic and diastolic functions and change in the NYHA functional class between baseline and three month follow up in patients.
Thirty five and 25 patients presented with HTNAP and NHTNAP, respectively (total 60). The overall mortality was 10 per cent (6/60). The number of hospitalizations was less in HTNAP category and of days of hospital stay was 6.3 in HTNAP and 9.8 in NHTNAP, the difference being significant (P < 0.001). The HTNAP category required less parenteral diuretics and inotropes compared with the NHTNAP category. The echocardiographic parameters showed better improvements in the HTNAP group as compared to the NHTNAP group. Overall, the patients in the <35 yr of age showed the best prognosis (P < 0.001).
INTERPRETATION & CONCLUSIONS: Normal or high blood pressure response at acute presentation of DCM leads to better prognosis which may be due to an intact renovascular and an active sympathetic system and can depict the stage of DCM.
扩张型心肌病（DCM）是一种进行性心脏疾病，伴有收缩和舒张功能障碍，长期预后较差。预后指数和死亡率预测指标被认为有助于指导治疗。本研究旨在评估初诊时高血压对肾血管和冠状动脉造影正常的DCM患者预后的影响。
对年龄在15至75岁之间、患有DCM且症状时有时无、在心脏病门诊接受治疗超过一年的患者进行了一项观察性、分析性、非干预性以及回顾性和前瞻性相结合的研究。60名符合纳入标准的患者被纳入研究。通过超声心动图以及纽约心脏协会（NYHA）功能分级对左心室收缩和舒张功能进行前瞻性评估，并在基线时进行回顾性评估。患者被分为两类：初诊时伴有高血压的DCM（HTNAP，第1类）和初诊时不伴有高血压的DCM（NHTNAP，第2类）。主要终点是住院时静脉用药的数量和剂量、住院时间以及以左心室射血分数表示的左心室（LV）收缩功能变化，次要终点包括总死亡率、左心室和右心室收缩及舒张功能变化以及患者在基线和三个月随访之间NYHA功能分级的变化。
分别有35例和25例患者表现为HTNAP和NHTNAP（共60例）。总死亡率为10%（6/60）。HTNAP组的住院次数较少，HTNAP组的住院天数为6.3天，NHTNAP组为9.8天，差异有统计学意义（P<0.001）。与NHTNAP组相比，HTNAP组所需的静脉利尿剂和正性肌力药物较少。超声心动图参数显示HTNAP组比NHTNAP组有更好的改善。总体而言，年龄<35岁的患者预后最佳（P<0.001）。
DCM急性发作时血压正常或升高导致预后较好，这可能归因于肾血管完整和交感神经系统活跃，并且可以描绘DCM的阶段。
