Department of Cardiovascular Medicine, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan.
Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
ESC Heart Fail. 2024 Jun;11(3):1463-1471. doi: 10.1002/ehf2.14711. Epub 2024 Feb 6.
Non-dilated left ventricular cardiomyopathy (NDLVC) was proposed as a new category of cardiomyopathy that included patients with non-left ventricular (LV) dilatation, LV wall motion abnormality, or LV scar. However, the clinical background and event rates of NDLVC were unclear. The aim of this study was to examine the characteristics and event rates of patients with NDLVC and reduced LV ejection fraction (NDLVC-REF) in comparison with those with dilated cardiomyopathy (DCM).
We retrospectively included 363 patients with newly diagnosed non-ischaemic cardiomyopathy and reduced LV ejection fraction (<50%) between December 2004 and January 2018. Patients who did not have LV dilatation (LV dimension index of ≦31 mm/m in men and ≦34 mm/m in women) were categorized as NDLVC-REF (n = 80, 22.2%), and the remaining patients were categorized as DCM. Cardiac events were defined as sudden cardiac death and rehospitalization for heart failure. Patients with NDLVC-REF had a higher prevalence of atrial fibrillation and a higher LV ejection fraction than those with DCM at baseline. LV ejection fraction was higher and LV end-diastolic diameter was smaller in patients with NDLVC-REF than in those with DCM at all time points after diagnosis. During the median follow-up period of 68.8 months (interquartile range: 33.0-93.7 months), 44 patients experienced cardiac events. The Kaplan-Meier curves showed no significant differences in the probability of cardiac events among NDLVC-REF and DCM patients (P = 0.349). However, patients with NDLVC-REF and LV dilatation after diagnosis (14%) had a higher risk of cardiac events than those with NDLVC-REF without LV dilatation (P = 0.049).
There was no significant difference in the incidence of cardiac events between NDLVC-REF and DCM. Among NDLVC-REF patients, 18% of patients who showed LV dilatation after diagnosis had poor outcomes. Therefore, both NDLVC-REF and DCM patients may require equivalent attention to follow-up and regular assessment of LV function.
非扩张性左心室心肌病（NDLVC）被提出作为一种新的心肌病类别，包括非左心室（LV）扩张、LV 壁运动异常或 LV 瘢痕的患者。然而，NDLVC 的临床背景和事件发生率尚不清楚。本研究旨在比较 NDLVC 合并左心室射血分数降低（NDLVC-REF）患者与扩张型心肌病（DCM）患者的特征和事件发生率。
我们回顾性纳入了 2004 年 12 月至 2018 年 1 月期间新诊断为非缺血性心肌病和左心室射血分数降低（<50%）的 363 例患者。未出现 LV 扩张（男性 LV 尺寸指数≦31mm/m，女性≦34mm/m）的患者被归类为 NDLVC-REF（n=80，22.2%），其余患者被归类为 DCM。心脏事件定义为心源性猝死和因心力衰竭再次住院。与 DCM 患者相比，NDLVC-REF 患者在基线时心房颤动的患病率更高，左心室射血分数更高。与 DCM 患者相比，NDLVC-REF 患者在诊断后的所有时间点左心室射血分数更高，LV 舒张末期直径更小。在中位随访 68.8 个月（四分位距：33.0-93.7 个月）期间，44 例患者发生心脏事件。Kaplan-Meier 曲线显示 NDLVC-REF 和 DCM 患者心脏事件的概率无显著差异（P=0.349）。然而，诊断后出现 LV 扩张的 NDLVC-REF 患者（14%）发生心脏事件的风险高于无 LV 扩张的 NDLVC-REF 患者（P=0.049）。
NDLVC-REF 和 DCM 患者的心脏事件发生率无显著差异。在 NDLVC-REF 患者中，18%的患者在诊断后出现 LV 扩张，预后较差。因此，NDLVC-REF 和 DCM 患者可能都需要同等关注随访，并定期评估左心室功能。
