Cho Jae Yeong, Kim Kye Hun, Song Ji Eun, Kim Ji Eun, Park Hyukjin, Yoon Hyun Ju, Yoon Nam Sik, Hong Young Joon, Park Hyung Wook, Kim Ju Han, Ahn Youngkeun, Jeong Myung Ho, Cho Jeong Gwan, Park Jong Chun
Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea.
Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea.
Heart Lung Circ. 2018 Jan;27(1):41-49. doi: 10.1016/j.hlc.2017.02.013. Epub 2017 Mar 20.
To identify the predictors of left ventricular functional recovery (LVFR) and its impacts on clinical outcomes in acute heart failure (AHF) patients with newly diagnosed dilated cardiomyopathy (DCM).
A total of 175 consecutive patients with newly diagnosed DCM and AHF were divided into two groups according to LVFR on FU echocardiography; the recovered group (n=54, 54.3±18.5years, 31 males) vs. the non-recovered group (n=121, 60.5±15.1years, 79 males). Clinical, laboratory, and echocardiographic findings were compared, and major adverse cardiac and cerebrovascular events (MACCE) including death, rehospitalisation, and stroke were analysed.
Left ventricular function (LV) was normalised in 54 patients (30.8%) on follow-up echocardiography. The change in the level of N-terminal pro-B-type natriuretic peptide (ΔNT-proBNP) between initial presentation and discharge >1633.5pg/mL was an independent predictor of LVFR, whereas diabetes and LV end-systolic diameter >50mm were negative predictors of LVFR on multivariate analysis. During five years of clinical follow-up, MACCE developed in 91 patients: 58 deaths, 29 rehospitalisations, and 4 strokes. On multivariate analysis, baseline LVEF <30% and no LVFR were independent predictors of MACCE.
Left ventricular functional recovery was not uncommon in newly diagnosed DCM with AHF. The changes in NT-proBNP level during hospitalisation, diabetes, and larger initial LV size were independent predictors of LVFR, and LVFR was an independent predictor of future MACCE. Serial monitoring of NT-proBNP and LV function would be useful in the risk stratification of newly diagnosed DCM with AHF.
确定新诊断为扩张型心肌病（DCM）的急性心力衰竭（AHF）患者左心室功能恢复（LVFR）的预测因素及其对临床结局的影响。
连续纳入175例新诊断为DCM和AHF的患者，根据随访超声心动图的LVFR分为两组；恢复组（n = 54，54.3±18.5岁，男性31例）与未恢复组（n = 121，60.5±15.1岁，男性79例）。比较临床、实验室和超声心动图检查结果，并分析包括死亡、再住院和中风在内的主要不良心脑血管事件（MACCE）。
随访超声心动图显示54例患者（30.8%）左心室功能（LV）恢复正常。初始就诊时与出院时N末端B型利钠肽原（ΔNT-proBNP）水平变化>1633.5 pg/mL是LVFR的独立预测因素，而糖尿病和LV舒张末期内径>50 mm在多因素分析中是LVFR的负性预测因素。在5年的临床随访中，91例患者发生了MACCE：58例死亡，29例再住院，4例中风。多因素分析显示，基线左心室射血分数（LVEF）<30%和无LVFR是MACCE的独立预测因素。
新诊断为DCM合并AHF的患者左心室功能恢复并不少见。住院期间NT-proBNP水平变化、糖尿病和初始LV较大是LVFR的独立预测因素，而LVFR是未来MACCE的独立预测因素。对新诊断为DCM合并AHF的患者进行NT-proBNP和LV功能的连续监测有助于风险分层。
