Winiarczyk Mateusz, Dziewięcka Ewa, Wiśniowska-Śmiałek Sylwia, Stępień Agnieszka, Graczyk Katarzyna, Leśniak-Sobelga Agata, Hlawaty Marta, Woźniak Jakub, Savitskaya Maryia, Holcman Katarzyna, Kostkiewicz Magdalena, Podolec Piotr, Rubiś Paweł
Doctoral School of Medical and Health Sciences, Jagiellonian University Medical College, Krakow, Poland.
Department of Cardiac and Vascular Diseases, Institute of Cardiology, John Paul II Hospital, Jagiellonian University Medical College, Krakow, Poland.
ESC Heart Fail. 2025 Apr;12(2):1183-1193. doi: 10.1002/ehf2.15119. Epub 2024 Nov 4.
The prognostic significance of left ventricular (LV) diastolic dysfunction (LVDD) severity in patients with dilated cardiomyopathy (DCM) remains uncertain. This study aimed to evaluate the association of LVDD severity and elevated left atrial pressure (eLAP) with patient outcomes in stable, non-acutely decompensated patients with DCM.
This single-centre, retrospective, observational study involved 740 DCM patients (either inpatients or outpatients) managed at our tertiary cardiac centre between 2010 and 2021. Due to incomplete data, 96 patients were excluded. LVDD and eLAP were assessed using echocardiography according to the 2016 guidelines of the European Association of Cardiovascular Imaging (EACVI). The primary outcomes were all-cause mortality and heart failure (HF)-related mortality.
The final cohort comprised of 644 DCM patients [mean age: 52 ± 12 years, LV ejection fraction (LVEF): 26 ± 10%]. Over a median follow-up period of 41 (18.5-66.7) months, 105 (16.3%) patients died: 8 (5.3%) patients in the normal left atrial pressure (nLAP) group and 97 (19.6%) patients in the eLAP group. eLAP was identified as an independent prognostic factor for both all-cause mortality [hazard ratio (HR) 2.0; 95% confidence interval (CI) 1.1-3.7; P = 0.01] and HF-related mortality (HR 2.5; 95% CI 1.01-6.5; P = 0.04), even after adjusting for LVEF and atrial fibrillation (AF) presence. Additionally, HF-related mortality rates were significantly higher in patients with moderate to severe LVDD compared with those with mild LVDD [5 (3.3%) vs. 67 (13.6%), P < 0.05].
This study's findings highlight the importance of assessing the severity of LVDD in patients with DCM, which provides incremental prognostic information over LVEF.
扩张型心肌病（DCM）患者左心室（LV）舒张功能障碍（LVDD）严重程度的预后意义仍不明确。本研究旨在评估稳定的、非急性失代偿的DCM患者中LVDD严重程度和左心房压力升高（eLAP）与患者预后的关系。
这项单中心、回顾性、观察性研究纳入了2010年至2021年间在我们的三级心脏中心接受治疗的740例DCM患者（包括住院患者和门诊患者）。由于数据不完整，排除了96例患者。根据欧洲心血管影像协会（EACVI）2016年指南，采用超声心动图评估LVDD和eLAP。主要结局是全因死亡率和心力衰竭（HF）相关死亡率。
最终队列包括644例DCM患者[平均年龄：52±12岁，左心室射血分数（LVEF）：26±10%]。在中位随访期41（18.5 - 66.7）个月内，105例（16.3%）患者死亡：正常左心房压力（nLAP）组8例（5.3%），eLAP组97例（19.6%）。即使在调整LVEF和心房颤动（AF）存在情况后，eLAP被确定为全因死亡率[风险比（HR）2.0；95%置信区间（CI）1.1 - 3.7；P = 0.01]和HF相关死亡率（HR 2.5；95% CI 1.01 - 6.5；P = 0.04）的独立预后因素。此外，中重度LVDD患者的HF相关死亡率显著高于轻度LVDD患者[5例（3.3%）对67例（13.6%），P < 0.05]。
本研究结果强调了评估DCM患者LVDD严重程度的重要性，其提供了超过LVEF的增量预后信息。
