Lewis J F, Webber J D, Sutton L L, Chesoni S, Curry C L
Department of Medicine, Howard University College of Medicine, Washington, D.C.
J Am Coll Cardiol. 1993 Mar 1;21(3):649-54. doi: 10.1016/0735-1097(93)90097-k.
The purpose of the present study was to assess the influence of variations in the relative degree of dilation of left and right ventricular chambers on the clinical outcome of patients with dilated cardiomyopathy.
Dilated cardiomyopathy, a primary myocardial disease characterized by ventricular dilation and systolic dysfunction, is generally associated with a poor prognosis. However, considerable variability has been observed in the clinical course and the morphologic and hemodynamic features in individual patients.
We evaluated 67 consecutive patients with dilated cardiomyopathy and without evidence of ischemic or primary valvular heart disease. On the basis of diastolic ventricular chamber area measurements obtained by echocardiography, patients were classified into two groups: 38 patients with a relatively equal degree of left and right ventricular dilation (LV congruent to RV) and 29 patients with predominant and disproportionate dilation of the left ventricle (LV > RV).
The 67 patients ranged in age from 19 to 81 years (mean 56); 49 (73%) were male. The two subsets of patients with dilated cardiomyopathy did not differ with regard to age, left ventricular diastolic dimension, wall thickness and mass or ejection fraction. However, patients in the LV congruent to RV group showed more severe mitral and tricuspid regurgitation by Doppler echocardiography than did those in the LV > RV group (p = 0.01 for mitral and 0.004 for tricuspid regurgitation). Over the follow-up period of 2 to 60 months (mean 28), there were 19 deaths. Survival in the LV > RV group was significantly better than in the LV congruent to RV group (p = 0.03).
Patients with dilated cardiomyopathy represent a heterogeneous group with regard to both clinical outcome and the relative degree of left and right ventricular chamber dilation. Patients in the LV > RV subset appear to have better overall survival and less severe mitral and tricuspid regurgitation than do patients in the LV congruent to RV subset. Longitudinal studies are needed to determine whether these morphologic subsets in fact represent a continuum within the disease spectrum of dilated cardiomyopathy.
本研究旨在评估左、右心室腔相对扩张程度的变化对扩张型心肌病患者临床结局的影响。
扩张型心肌病是一种以心室扩张和收缩功能障碍为特征的原发性心肌疾病，通常预后较差。然而，在个体患者的临床病程以及形态学和血流动力学特征方面已观察到相当大的变异性。
我们评估了67例连续的扩张型心肌病患者，这些患者无缺血性或原发性瓣膜性心脏病证据。根据超声心动图测得的舒张期心室腔面积，将患者分为两组：38例左、右心室扩张程度相对相等的患者（左心室与右心室相当）和29例左心室为主且不成比例扩张的患者（左心室>右心室）。
67例患者年龄在19至81岁之间（平均56岁）；49例（73%）为男性。扩张型心肌病患者的这两个亚组在年龄、左心室舒张内径、壁厚和质量或射血分数方面无差异。然而，左心室与右心室相当组的患者经多普勒超声心动图检查显示二尖瓣和三尖瓣反流比左心室>右心室组更严重（二尖瓣反流p = 0.01，三尖瓣反流p = 0.004）。在2至60个月（平均28个月）的随访期内有19例死亡。左心室>右心室组的生存率显著高于左心室与右心室相当组（p = 0.03）。
扩张型心肌病患者在临床结局以及左、右心室腔相对扩张程度方面是一个异质性群体。左心室>右心室亚组的患者似乎比左心室与右心室相当亚组的患者总体生存率更高，二尖瓣和三尖瓣反流也较轻。需要进行纵向研究以确定这些形态学亚组是否实际上代表扩张型心肌病疾病谱中的一个连续体。
