Iliuță Luminita, Andronesi Andreea Gabriella, Rac-Albu Marius, Rac-Albu Mădălina-Elena, Scafa-Udriște Alexandru, Moldovan Horațiu, Furtunescu Florentina Ligia, Rădulescu Bogdan Constantin, Panaitescu Eugenia
Medical Informatics and Biostatistics Department, University of Medicine and Pharmacy "Carol Davila", 050474 Bucharest, Romania.
Cardioclass Clinic for Cardiovascular Disease, 031125 Bucharest, Romania.
J Cardiovasc Dev Dis. 2023 May 28;10(6):237. doi: 10.3390/jcdd10060237.
(1) Background: The presence of restrictive left ventricular diastolic filling pattern (LVDFP) is associated with an unfavorable prognosis in many cardiac diseases, but few data are available on the prognostic implications of this pattern in patients with dilated cardiomyopathy (DCM). We aimed to establish the main prognostic predictors at the 1- and 5-year follow-ups in DCM patients and the value of restrictive LVDFP in increasing morbidity and mortality. (2) Methods: A prospective study of 143 patients with DCM divided in non-restrictive LVDFP group (95 patients) and restrictive group (47 patients). The patients were evaluated at a 5-year follow-up through an in-patient visit during the pre-pandemic period and hybrid methods (face-to-face, teleconsultation and home monitoring with a telemedicine application) during the pandemic period. Statistical analysis compared the two groups in terms of NYHA class, quality of life, hospitalizations/emergency department (ED) visits due to HF exacerbation and total mortality. (3) Results: The mortality rate in the restrictive group was markedly higher than that in the non-restrictive group at 1 year (17.02% vs. 10.59%, respectively, < 0.05) and at 5 years (68.08% vs. 50.53%, < 0.05). In the restrictive group, hospitalizations/ED visits due to HF decompensations at 1 year were significantly higher (85.11% vs. 57.89%, < 0.05), with hospitalizations for ventricular arrhythmia being almost three times higher (21.28% vs. 7.37%, respectively, < 0.05). The percentage of patients with a favorable evolution (in terms of NYHA class and quality of life) at the 1- and 5-year follow-ups were higher in the non-restrictive LVDFP group. The main prognostic predictors in patients with DCM at the 1-year follow-up were: restrictive LVDFP, age > 75 years, markedly dilated LV, comorbidities (DM, COPD), 2nd-degree mitral regurgitation and severe pulmonary hypertension ( < 0.05). (4) Conclusions: At the 1- and 5-year follow-ups, the presence of the restrictive LVDFP in DCM patients was independently associated with a poor prognosis, being the best clinical predictor for unfavorable evolution, after adjustment for other well-established predictive parameters in DCM patients.
（1）背景：限制性左心室舒张充盈模式（LVDFP）的存在与许多心脏疾病的不良预后相关，但关于这种模式在扩张型心肌病（DCM）患者中的预后意义的数据较少。我们旨在确定DCM患者1年和5年随访时的主要预后预测因素以及限制性LVDFP在增加发病率和死亡率方面的价值。（2）方法：对143例DCM患者进行前瞻性研究，分为非限制性LVDFP组（95例患者）和限制性组（47例患者）。在大流行前时期通过住院就诊对患者进行5年随访评估，在大流行期间采用混合方法（面对面、远程会诊以及使用远程医疗应用程序进行家庭监测）。统计分析比较了两组在纽约心脏协会（NYHA）心功能分级、生活质量、因心力衰竭加重导致的住院/急诊就诊次数以及总死亡率方面的差异。（3）结果：限制性组在1年时的死亡率显著高于非限制性组（分别为17.02%对10.59%，P<0.05），在5年时也是如此（68.08%对50.53%，P<0.05）。在限制性组中，1年时因心力衰竭失代偿导致的住院/急诊就诊次数显著更高（85.11%对57.89%，P<0.05），因室性心律失常住院的次数几乎高出三倍（分别为21.28%对7.37%，P<0.05）。在1年和5年随访时，非限制性LVDFP组中病情呈良好进展（根据NYHA心功能分级和生活质量）的患者百分比更高。DCM患者1年随访时的主要预后预测因素为：限制性LVDFP、年龄>75岁、左心室明显扩张、合并症（糖尿病、慢性阻塞性肺疾病）、二尖瓣反流二级以及重度肺动脉高压（P<0.05）。（4）结论：在1年和5年随访时，DCM患者中限制性LVDFP的存在与不良预后独立相关，在对DCM患者其他已确立的预测参数进行调整后，它是不良病情进展的最佳临床预测因素。
