Li Mengwan, Liu Wenheng, Mi Shouling, Wang Meng, Wang Yanli, Guo Qilong, Lian Zhexun, Ge Junhua
Department of Cardiology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, China.
Qingdao Municipal Key Laboratory of Hypertension (Key Laboratory of Cardiovascular Medicine), Qingdao, Shandong Province, China.
Cardiovasc Ther. 2025 Mar 8;2025:2122089. doi: 10.1155/cdr/2122089. eCollection 2025.
This study is aimed at identifying clinical and echocardiographic factors associated with all-cause mortality or heart transplantation (HTx) in young patients with dilated cardiomyopathy (DCM). We conducted a retrospective analysis of hospitalized patients (aged 18-45 years) diagnosed with DCM between January 2012 and December 2022. All patients underwent a 2-year medical therapy for heart failure, followed by at least 1 year of follow-up. Clinical and echocardiographic data were collected at baseline and after the 2-year treatment period. Multivariate Cox proportional hazards regression with a backward stepwise method was used to identify risk factors for all-cause mortality or HTx. The study cohort comprised 67 patients. Over a median follow-up of 38 months (range 18-50), 15 patients died and 24 underwent HTx. Significant risk factors for all-cause mortality/HTx included smoking, digoxin use, elevated N-terminal pro-brain natriuretic peptide (NT-proBNP, ≥ 5678 pg/mL), higher C-reactive protein (CRP, ≥ 3.0 mg/L), higher uric acid (UA, ≥ 570 mol/L), lower left ventricular ejection fraction (LVEF, ≤25%), and enlarged end-diastolic left ventricular diameter (LVD, ≥ 65 mm). Among these, elevated CRP (hazard ratio, HR = 6.727, < 0.001) and enlarged LVD (HR = 3.038, = 0.007) were the strongest independent risk factors, irrespective of other risk factors. Moreover, each 5 mm annual increase in end-systolic left atrial diameter (LAD, HR = 3.641, < 0.001) and each unit annual increase in Ln(NT-proBNP) (HR = 4.069, < 0.001) were the strongest predictors of all-cause mortality/HTx, even after accounting for the effects of body mass index, duration of treatment, and baseline CRP level. Intensive monitoring and medical care may be beneficial for young adult DCM patients with defined risk factors such as smoking, elevated NT-proBNP and CRP, lower LVEF, and enlarged LV diameter. Our findings suggest that personalized intensive monitoring and medical care based on identified risk factors may improve outcomes in young adult DCM patients.
本研究旨在确定与扩张型心肌病（DCM）年轻患者全因死亡率或心脏移植（HTx）相关的临床和超声心动图因素。我们对2012年1月至2022年12月期间诊断为DCM的住院患者（年龄18 - 45岁）进行了回顾性分析。所有患者接受了为期2年的心力衰竭药物治疗，随后进行了至少1年的随访。在基线和2年治疗期后收集了临床和超声心动图数据。采用多变量Cox比例风险回归和向后逐步法来确定全因死亡率或HTx的危险因素。研究队列包括67例患者。在中位随访38个月（范围18 - 50个月）期间，15例患者死亡，24例接受了HTx。全因死亡率/HTx的显著危险因素包括吸烟、使用地高辛、N末端脑钠肽前体（NT - proBNP）升高（≥5678 pg/mL）、C反应蛋白（CRP）升高（≥3.0 mg/L）、尿酸（UA）升高（≥570 μmol/L）、左心室射血分数（LVEF）降低（≤25%）以及舒张末期左心室直径增大（LVD，≥65 mm）。其中，CRP升高（风险比，HR = 6.727，P < 0.001）和LVD增大（HR = 3.038，P = 0.007）是最强的独立危险因素，与其他危险因素无关。此外，即使在考虑了体重指数、治疗持续时间和基线CRP水平的影响后，收缩末期左心房直径（LAD）每年每增加5 mm（HR = 3.641，P < 0.001）和Ln(NT - proBNP)每年每增加1个单位（HR = 4.069，P < 0.001）也是全因死亡率/HTx的最强预测因素。对于有吸烟、NT - proBNP和CRP升高、LVEF降低以及左心室直径增大等明确危险因素的年轻成年DCM患者，强化监测和医疗护理可能有益。我们的研究结果表明，基于已确定危险因素的个性化强化监测和医疗护理可能改善年轻成年DCM患者的预后。
