Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), University of Trieste, Italy.
Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), University of Trieste, Italy.
Int J Cardiol. 2023 Nov 1;390:131252. doi: 10.1016/j.ijcard.2023.131252. Epub 2023 Aug 8.
Cardiopulmonary exercise testing (CPET) is a recognized tool for prognostic stratification in patients with dilated cardiomyopathy (DCM). Given the lack of data currently available, the aim of this study was to test the prognostic value of repeating CPET during the follow-up of patients with DCM.
This multicenter, retrospective study, analyzed DCM patients who consecutively performed two echocardiographies and CPETs during clinical stability. The study end-point was a composite of death from all causes, heart transplantation, left ventricular assist device implantation, life-threatening ventricular arrhythmias or hospitalization for heart failure.
216 DCM patients were enrolled (52 years, 78% male, NYHA I-II 82%, LVEF 32%, 94% on ACE inhibitors/ARNI, 95% on beta-blockers). The interval between CPETs was 15 months. During a median follow-up of 38 months from the second CPET, 102 (47%) patients experienced the study end-point. Among them, there was stability of echocardiographic values but a significant worsening of functional capacity. Among the 173 patients (80%) who did not show echocardiographic left ventricular reverse remodeling (LVRR), the 1-year prevalence of the study-end point was higher in patients who worsened vs patients who maintained stable their functional capacity at CPET (38 vs. 15% respectively, p-value: 0.001). These results were consistent also when excluding life-threatening ventricular arrhythmias from the composite end-point.
In clinically stable DCM patients with important depression of LVEF, the repetition of combined echocardiography and CPET might be recommended. When LVRR fails, 1-year repetition of CPET could identify higher-risk patients.
心肺运动测试（CPET）是一种用于扩张型心肌病（DCM）患者预后分层的公认工具。鉴于目前缺乏数据，本研究旨在测试在 DCM 患者的随访中重复进行 CPET 的预后价值。
这项多中心、回顾性研究分析了在临床稳定期间连续进行两次超声心动图和 CPET 的 DCM 患者。研究终点是全因死亡、心脏移植、左心室辅助装置植入、危及生命的室性心律失常或心力衰竭住院的复合终点。
共纳入 216 例 DCM 患者（52 岁，78%为男性，NYHA I-II 级 82%，LVEF 32%，94%服用 ACE 抑制剂/ARB，95%服用β受体阻滞剂）。CPET 两次检查之间的间隔为 15 个月。在第二次 CPET 后中位数为 38 个月的随访期间，102 例（47%）患者出现了研究终点。其中，超声心动图值保持稳定，但功能容量显著恶化。在 173 例（80%）未出现超声心动图左心室逆向重构（LVRR）的患者中，CPET 时功能容量恶化的患者比功能容量保持稳定的患者研究终点 1 年发生率更高（分别为 38%和 15%，p 值：0.001）。当将复合终点中的危及生命的室性心律失常排除在外时，结果仍然一致。
在重要的 LVEF 降低的临床稳定的 DCM 患者中，建议重复进行联合超声心动图和 CPET。当 LVRR 失败时，CPET 的 1 年重复检查可识别更高风险的患者。
