Galand Vincent, Flécher Erwan, Chabanne Céline, Lelong Bernard, Goéminne Céline, Vincentelli André, Delmas Clément, Dambrin Camille, Picard François, Sacher Frédéric, Kindo Michel, Minh Tam Hoang, Gaudard Philippe, Rouvière Philippe, Sénage Thomas, Michel Magali, Boignard Aude, Chavanon Olivier, Verdonk Constance, Ghodhbane Walid, Pelcé Edeline, Gariboldi Vlad, Pozzi Matteo, Obadia Jean-François, Litzler Pierre-Yvesl, Anselme Frédéric, Babatasi Gerard, Blanchart Katrien, Garnier Fabien, Bielefeld Marie, Hamon David, Lellouche Nicolas, Bourguignon Thierry, Genet Thibaud, Eschalier Romain, D'Ostrevy Nicolas, Varlet Emilie, Jouan Jérôme, Vanhuyse Fabrice, Blangy Hugues, Leclercq Christophe, Martins Raphaël P
Univ Rennes, CHU Rennes, INSERM, Rennes, France.
Univ Rennes, CHU Rennes, INSERM, Rennes, France.
Am J Cardiol. 2020 May 1;125(9):1421-1428. doi: 10.1016/j.amjcard.2020.01.042. Epub 2020 Feb 8.
The impact of uncommon etiology cardiomyopathies on Left-ventricular assist device (LVAD)-recipient outcomes is not very well known. This study aimed to characterize patients with uncommon cardiomyopathy etiologies and examine the outcomes between uncommon and ischemic/idiopathic dilated cardiomyopathy. This observational study was conducted in 19 centers between 2006 and 2016. Baseline characteristics and outcomes of patients with uncommon etiology were compared to patients with idiopathic dilated/ischemic cardiomyopathies. Among 652 LVAD-recipients included, a total of 590 (90.5%) patients were classified as ischemic/idiopathic and 62 (9.5%) patients were classified in the "uncommon etiologies" group. Main uncommon etiologies were: hypertrophic (n = 12(19%)); cancer therapeutics-related cardiac dysfunction (CTRCD) (n = 12(19%)); myocarditis (n = 11(18%)); valvulopathy (n = 9(15%)) and others (n = 18(29%)). Patients with uncommon etiologies were significantly younger with more female and presented less co-morbidities. Additionally, patients with uncommon cardiomyopathies were less implanted as destination therapy compared with ischemic/idiopathic group (29% vs 38.8%). During a follow-up period of 9.1 months, both groups experienced similar survival. However, subgroup of hypertrophic/valvular cardiomyopathies and CTRCD had significantly higher mortality compared to the ischemic/idiopathic or myocarditis/others cardiomyopathies. Conversely, patients with myocarditis/others etiologies experienced a better survival. Indeed, the 12-months survival in the myocarditis/others; ischemic/idiopathic and hypertrophic/CTRCD/valvulopathy group were 77%; 65%, and 46% respectively. In conclusion, LVAD-recipients with hypertrophic cardiomyopathy, valvular heart disease and CTRCD experienced the higher mortality rate.
病因罕见的心肌病对左心室辅助装置(LVAD)接受者预后的影响尚不十分清楚。本研究旨在对病因罕见的心肌病患者进行特征描述,并比较病因罕见的心肌病与缺血性/特发性扩张型心肌病的预后情况。这项观察性研究于2006年至2016年在19个中心开展。将病因罕见的患者的基线特征和预后与特发性扩张型/缺血性心肌病患者进行比较。在纳入的652例LVAD接受者中,共有590例(90.5%)患者被归类为缺血性/特发性心肌病,62例(9.5%)患者被归类为“病因罕见”组。主要的罕见病因包括:肥厚型(n = 12(19%));癌症治疗相关心脏功能障碍(CTRCD)(n = 12(19%));心肌炎(n = 11(18%));瓣膜病(n = 9(15%))以及其他(n = 18(29%))。病因罕见的患者明显更年轻,女性更多,合并症更少。此外,与缺血性/特发性组相比,病因罕见的心肌病患者作为终末期治疗植入LVAD的比例更低(29%对38.8%)。在9.1个月的随访期内,两组的生存率相似。然而,肥厚型/瓣膜性心肌病和CTRCD亚组的死亡率显著高于缺血性/特发性或心肌炎/其他心肌病亚组。相反,病因是心肌炎/其他的患者生存率更高。事实上,心肌炎/其他病因组、缺血性/特发性组以及肥厚型/CTRCD/瓣膜病组的12个月生存率分别为77%、65%和46%。总之,患有肥厚型心肌病、瓣膜性心脏病和CTRCD的LVAD接受者死亡率更高。