Karatolios Konstantinos, Holzendorf Volker, Hatzis George, Tousoulis Dimitrios, Richter Anette, Schieffer Bernhard, Pankuweit Sabine
Department of Cardiology, Angiology and Intensive Care, Philipps University Marburg, Marburg, Germany.
Clinical Trial Center Leipzig, Faculty of Medicine, University of Leipzig, Leipzig, Germany.
PLoS One. 2017 Dec 21;12(12):e0188491. doi: 10.1371/journal.pone.0188491. eCollection 2017.
The study objectives were to identify predictors of outcome in patients with inflammatory dilated cardiomyopathy (DCMi).
From 2004 to 2008, 55 patients with biopsy-proven DCMi were identified and followed up for 58.2±19.8 months. Predictors of outcome were identified in a multivariable analysis with a Cox proportional hazards analysis. The primary endpoint was a composite of death, heart transplantation and hospitalization for heart failure or ventricular arrhythmias.
For the primary endpoint, a QTc interval >440msec (HR 2.84; 95% CI 1.03-7.87; p = 0.044), a glomerular filtration rate (GFR) <60ml/min/1.73m2 (HR 3.19; 95% CI 1.35-7.51; p = 0.008) and worsening of NYHA classification during follow-up (HR 2.48; 95% CI 1.01-6.10; p = 0.048) were univariate predictors, whereas left ventricular ejection fraction at baseline, NYHA class at entry, atrial fibrillation, treatment with digitalis or viral genome detection were not significantly related to outcome. After multivariable analysis, a GFR <60ml/min/1.73m2 (HR 3.04; 95% CI 1.21-7.66; p = 0.018) remained a predictor of adverse outcome.
In patients with DCMi, a prolonged QTc interval >440msec, a GFR<60ml/min/1.73m2 and worsening of NYHA classification during follow-up were univariate predictors of adverse prognosis. In contrast, NYHA classification at baseline, left ventricular ejection fraction, atrial fibrillation, treatment with digitalis or viral genome detection were not related to outcome. After multivariable analysis, a GFR <60ml/min/1.73m2 remained independently associated with adverse outcome.
本研究旨在确定炎症性扩张型心肌病（DCMi）患者预后的预测因素。
2004年至2008年，共纳入55例经活检证实的DCMi患者，随访时间为58.2±19.8个月。通过Cox比例风险分析进行多变量分析，确定预后的预测因素。主要终点为死亡、心脏移植以及因心力衰竭或室性心律失常住院的综合情况。
对于主要终点，单因素预测因素包括QTc间期>440毫秒（HR 2.84；95%CI 1.03 - 7.87；p = 0.044）、肾小球滤过率（GFR）<60ml/min/1.73m²（HR 3.19；95%CI 1.35 - 7.51；p = 0.008）以及随访期间纽约心脏协会（NYHA）分级恶化（HR 2.48；95%CI 1.01 - 6.10；p = 0.048），而基线左心室射血分数、入院时NYHA分级、心房颤动、洋地黄治疗或病毒基因组检测与预后无显著相关性。多变量分析后，GFR<60ml/min/1.73m²（HR 3.04；95%CI 1.21 - 7.66；p = 0.018）仍是不良预后的预测因素。
在DCMi患者中，QTc间期延长>440毫秒、GFR<60ml/min/1.73m²以及随访期间NYHA分级恶化是不良预后的单因素预测因素。相比之下，基线NYHA分级、左心室射血分数、心房颤动、洋地黄治疗或病毒基因组检测与预后无关。多变量分析后，GFR<60ml/min/1.73m²仍与不良预后独立相关。
