Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan.
Department of Radiology, Nippon Medical School, Tokyo, Japan.
ESC Heart Fail. 2020 Apr;7(2):682-691. doi: 10.1002/ehf2.12662. Epub 2020 Mar 9.
This study aims to determine the implications associated with long-term prognosis of heart failure (HF) in patients with dilated cardiomyopathy (DCM) presenting initially as decompensated HF. We stratified the phase of DCM patients without late gadolinium enhancement (LGE) based on ultrastructural changes in cardiomyocytes.
Left ventricular (LV) endomyocardial biopsy was performed in 55 consecutive DCM patients with initial decompensated HF. Ultrastructural changes in cardiomyocytes detected by electron microscopy were compared with data including LGE with cardiac magnetic resonance and HF recurrence. Of the 55 DCM patients, 24 (44%) showed LGE, and 26 (47%) showed recurrence decompensated HF, while 23 patients (42%) showed autophagic vacuoles in cardiomyocytes by electron microscopy. Multivariate analysis identified atrial fibrillation [hazard ratio (HR), 3.40; 95% confidence interval (CI), 1.45-7.98], haemoglobin level (HR, 0.82; 95% CI, 0.68-0.99), beta-blocker use (HR, 0.18; 95% CI, 0.05-0.74), and autophagic vacuoles (HR, 0.25; 95% CI, 0.09-0.65) as predictors of HF recurrence in the total patient population. In patients without LGE, only autophagic vacuoles were independent predictors of readmission because of HF (HR, 0.29; 95% CI, 0.09-0.90). In patients with LGE, atrial fibrillation (HR, 19.10; 95% CI, 2.97-123.09), and mid-linear LGE (HR, 12.96; 95% CI, 2.02-82.94) were independent predictors of readmission because of HF.
In DCM patients with LGE, characterised by progression of LV remodelling, the LGE pattern was a predictor of HF recurrence, whereas in patients without LGE, absence of autophagic vacuoles was a predictor of HF recurrence.
本研究旨在确定扩张型心肌病（DCM）患者心力衰竭（HF）长期预后的意义，这些患者最初表现为失代偿性 HF。我们根据心肌细胞的超微结构变化对无晚期钆增强（LGE）的 DCM 患者进行了分期。
对 55 例连续的初始失代偿性 HF 的 DCM 患者进行左心室（LV）心内膜心肌活检。通过电子显微镜比较心肌细胞的超微结构变化与包括心脏磁共振 LGE 和 HF 复发的数据。55 例 DCM 患者中，24 例（44%）出现 LGE，26 例（47%）出现复发的失代偿性 HF，而 23 例（42%）通过电子显微镜观察到心肌细胞中有自噬空泡。多变量分析确定了心房颤动[风险比（HR），3.40；95%置信区间（CI），1.45-7.98]、血红蛋白水平（HR，0.82；95%CI，0.68-0.99）、β受体阻滞剂的使用（HR，0.18；95%CI，0.05-0.74）和自噬空泡（HR，0.25；95%CI，0.09-0.65）是总患者人群 HF 复发的预测因子。在无 LGE 的患者中，只有自噬空泡是 HF 再入院的独立预测因子（HR，0.29；95%CI，0.09-0.90）。在有 LGE 的患者中，心房颤动（HR，19.10；95%CI，2.97-123.09）和中线性 LGE（HR，12.96；95%CI，2.02-82.94）是 HF 再入院的独立预测因子。
在 LGE 特征为 LV 重构进展的 DCM 患者中，LGE 模式是 HF 复发的预测因子，而在无 LGE 的患者中，无自噬空泡是 HF 复发的预测因子。
