Kimura Yuki, Okumura Takahiro, Morimoto Ryota, Kazama Shingo, Shibata Naoki, Oishi Hideo, Araki Takashi, Mizutani Takashi, Kuwayama Tasuku, Hiraiwa Hiroaki, Kondo Toru, Murohara Toyoaki
Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.
ESC Heart Fail. 2021 Apr;8(2):1359-1368. doi: 10.1002/ehf2.13216. Epub 2021 Jan 20.
Left ventricular reverse remodelling (LVRR) is a well-established predictor of a good prognosis in patients with dilated cardiomyopathy (DCM). The prediction of LVRR is important when developing a long-term treatment strategy. This study aimed to assess the clinical predictors of LVRR and establish a scoring system for predicting LVRR in patients with DCM that can be used at any institution.
We consecutively enrolled 131 patients with DCM and assessed the clinical predictors of LVRR. LVRR was defined as an absolute increase in left ventricular ejection fraction (LVEF) from ≥10% to a final value of >35%, accompanied by a decrease in left ventricular end-diastolic dimension (LVEDD) ≥ 10% on echocardiography at 1 ± 0.5 years after a diagnosis of DCM. The mean patient age was 50.1 ± 11.9 years. The mean LVEF was 32.2 ± 9.5%, and the mean LVEDD was 64.1 ± 12.5 mm at diagnosis. LVRR was observed in 45 patients (34%) at 1 ± 0.5 years. In a multivariate analysis, hypertension [odds ratio (OR): 6.86; P = 0.002], no family history of DCM (OR: 10.45; P = 0.037), symptom duration <90 days (OR: 6.72; P < 0.001), LVEF <35% (OR: 13.66; P < 0.0001), and QRS duration <116 ms (OR: 5.94; P = 0.005) were found to be independent predictors of LVRR. We scored the five independent predictors according to the ORs (1 point, 2 points, 1 point, 2 points, and 1 point, respectively), and the total LVRR predicting score was calculated by adding these scores. The LVRR rate was stratified by the LVRR predicting score (0-2 points: 0%; 3 points: 6.7%; 4 points: 17.4%; 5 points: 48.2%; 6 points: 79.2%; and 7 points: 100%). The cut-off value of the LVRR predicting score was >5 in receiver-operating characteristic curve analysis (area under the curve: 0.89; P < 0.0001; sensitivity: 87%; specificity: 78%). An LVRR predicting score of >5 was an independent predictor compared with the presence of late gadolinium enhancement on cardiovascular magnetic resonance or the severity of fibrosis on endomyocardial biopsy (OR: 11.79; 95% confidence interval: 2.40-58.00; P = 0.002).
The LVRR predicting score using five predictors including hypertension, no family history of DCM, symptom duration <90 days, LVEF <35%, and QRS duration <116 ms can stratify the LVRR rate in patients with DCM. The LVRR predicting score may be a useful clinical tool that can be used easily at any institution.
左心室逆向重构（LVRR）是扩张型心肌病（DCM）患者预后良好的公认预测指标。在制定长期治疗策略时，LVRR的预测很重要。本研究旨在评估LVRR的临床预测因素，并建立一个可在任何机构使用的DCM患者LVRR预测评分系统。
我们连续纳入了131例DCM患者，并评估了LVRR的临床预测因素。LVRR定义为在DCM诊断后1±0.5年时，经超声心动图检查，左心室射血分数（LVEF）绝对增加≥10%至最终值>35%，同时左心室舒张末期内径（LVEDD）减少≥10%。患者平均年龄为50.1±11.9岁。诊断时平均LVEF为32.2±9.5%，平均LVEDD为64.1±12.5mm。在1±0.5年时，45例患者（34%）出现LVRR。多因素分析显示，高血压[比值比（OR）：6.86；P=0.002]、无DCM家族史（OR：10.45；P=0.037）、症状持续时间<90天（OR：6.72；P<0.001）、LVEF<35%（OR：13.66；P<0.0001）以及QRS波时限<116ms（OR：5.94；P=0.005）是LVRR的独立预测因素。我们根据OR值对这五个独立预测因素进行评分（分别为1分、2分、1分、2分和1分），并通过将这些分数相加计算出LVRR预测总分。根据LVRR预测评分对LVRR发生率进行分层（0 - 2分：0%；3分：6.7%；4分：17.4%；5分：48.2%；6分：79.2%；7分：100%）。在受试者工作特征曲线分析中，LVRR预测评分的截断值>5（曲线下面积：0.89；P<0.0001；敏感性：87%；特异性：78%）。与心血管磁共振成像上延迟钆增强的存在或心内膜心肌活检中纤维化的严重程度相比，LVRR预测评分>5是一个独立的预测因素（OR：11.79；95%置信区间：2.40 - 58.00；P=0.002）。
使用包括高血压、无DCM家族史、症状持续时间<90天、LVEF<35%和QRS波时限<116ms这五个预测因素的LVRR预测评分，可以对DCM患者的LVRR发生率进行分层。LVRR预测评分可能是一种有用的临床工具，可在任何机构轻松使用。
