非缺血性扩张型心肌病的预后决定因素

Determinants of prognosis in nonischemic dilated cardiomyopathy.

作者信息

Grzybowski J, Bilińska Z T, Ruzyłło W, Kupść W, Michalak E, Szcześniewska D, Poplawska W, Rydlewska-Sadowska W

机构信息

Department of General Cardiology, National Institute of Cardiology, Warsaw, Poland.

出版信息

J Card Fail. 1996 Jun;2(2):77-85. doi: 10.1016/s1071-9164(96)80026-1.

DOI:10.1016/s1071-9164(96)80026-1

PMID:8798109

Abstract

BACKGROUND

Dilated cardiomyopathy, a heart muscle disease of unknown cause, is characterized by high mortality and is a major cause of cardiac transplantation. It has become, therefore, increasingly important to identify patients at higher risk. The aim of this study was to assess which of the data obtained at the time of diagnosis are the best predictors of survival.

METHODS AND RESULTS

One hundred forty-four patients with dilated cardiomyopathy (118 men; mean age, 39 years) were assessed clinically, noninvasively, and hemodynamically. The effect of variables derived from the evaluation on outcome (death or heart transplantation) was examined. During a mean follow-up time of 4.1 years, 68 patients (47%) died and 9 (6%) underwent heart transplantation. The 1-, 2-, and 5-year transplant-free survival rate was 79, 69, and 44%, respectively. Cox multivariate regression analysis identified three variables as independent predictors of outcome: (1) pulmonary artery systolic pressure, P = .0001; (2) left ventricular ejection fraction, P = .0013; and (3) left ventricular end-diastolic dimension, P = .007. The prognostic index was constructed from regression coefficients and parameters significant in the Cox model. The minimal prognostic index in the study group was 1.4 and the maximal was 6.0 with a corresponding 1-year survival of 98 and 18%, respectively. The validity of the prognostic index was tested in the consecutive group of 81 patients, who were followed for a mean 2.3 years. The prognostic index of the poor outcome group differed significantly from that in survivors (3.7 vs 2.9, respectively, P < .01). The sensitivity and specificity of model predictions were 68 and 52%, respectively.

CONCLUSIONS

The severity of pulmonary hypertension and left ventricular dysfunction provides an independent insight into the prognosis of patients with dilated cardiomyopathy. The prognostic index is useful when assessing prognosis and may be helpful in the timing of heart transplantation.

摘要

背景

扩张型心肌病是一种病因不明的心肌疾病，其特点是死亡率高，是心脏移植的主要原因。因此，识别高危患者变得越来越重要。本研究的目的是评估诊断时获得的数据中哪些是生存的最佳预测指标。

方法与结果

对144例扩张型心肌病患者（118例男性；平均年龄39岁）进行了临床、非侵入性和血流动力学评估。检查了评估得出的变量对结局（死亡或心脏移植）的影响。在平均4.1年的随访期内，68例患者（47%）死亡，9例（6%）接受了心脏移植。1年、2年和5年无移植生存率分别为79%、69%和44%。Cox多变量回归分析确定了三个变量为结局的独立预测指标：（1）肺动脉收缩压，P = 0.0001；（2）左心室射血分数，P = 0.0013；（3）左心室舒张末期内径，P = 0.007。根据回归系数和Cox模型中有意义的参数构建了预后指数。研究组的最小预后指数为1.4，最大为6.0，相应的1年生存率分别为98%和18%。在连续的81例患者组中测试了预后指数的有效性，这些患者平均随访2.3年。预后不良组的预后指数与幸存者的预后指数有显著差异（分别为3.7和2.9，P < 0.01）。模型预测的敏感性和特异性分别为68%和52%。