PMID- 23240370
OWN - NLM
STAT- MEDLINE
DCOM- 20130108
LR  - 20131121
IS  - 1565-1088 (Print)
VI  - 14
IP  - 11
DP  - 2012 Nov
TI  - The variable natural history of idiopathic dilated cardiomyopathy.
PG  - 666-71
AB  - BACKGROUND: Determining the prognosis of patients with heart failure is essential 
      for patient management and clinical trial conduct. The relative value of 
      traditional prognostic criteria remains unclear and the assessment of long-term 
      prognosis for individual patients is problematic. OBJECTIVES: To determine the 
      ability of clinical, hemodynamic and echocardiographic parameters to predict the 
      long-term prognosis of patients with idiopathic dilated cardiomyopathy. METHODS: 
      We investigated the ability of clinical, hemodynamic and echocardiographic 
      parameters to predict the long-term prognosis of individual patients in a large, 
      representative, contemporary cohort of idiopathic dilated cardiomyopathy (IDCM) 
      patients referred to Johns Hopkins from 1997 to 2004 for evaluation of 
      cardiomyopathy. In all patients a baseline history was taken, and physical 
      examination, laboratory studies, echocardiogram, right heart catheterization and 
      endomyocardial biopsy were performed. RESULTS: In 171 IDCM patients followed for 
      a median 3.5 years, there were 50 long-term event-free survivors (LTS) (median 
      survival 6.4 years) and 34 patients died or underwent ventricular assist device 
      placement or transplantation within 5 years (NLTS; non-long-term survivors) 
      (median time to event 1.83 years. Established risk factors (gender, race, 
      presence of diabetes, serum creatinine, sodium) and the use of accepted heart 
      failure medications (angiotensin-converting enzyme inhibitors, angiotensin 
      receptor blockers, beta blockers) were similar between the two groups. Although 
      LTS had younger age, higher ejection fraction (EF) and lower New York Heart 
      Association (NYHA) class at presentation, the positive predictive value of an EF 
      < 25% was 64% (95% CI 41%-79%) and that of NYHA class > 2 was 53% (95% CI 
      36-69%). A logistic model incorporating these three variables incorrectly 
      classified 29% of patients. CONCLUSIONS: IDCM exhibits a highly variable natural 
      history and standard clinical predictors have limited ability to classify IDCM 
      patients into broad prognostic categories. These findings suggest that there are 
      important host-environmental factors still unappreciated in the biology of IDCM.
FAU - Parakh, Kapil
AU  - Parakh K
AD  - Department of Medicine, Johns Hopkins Bayview Medical Center, Baltimore, MD, USA.
FAU - Kittleson, Michelle M
AU  - Kittleson MM
FAU - Heidecker, Bettina
AU  - Heidecker B
FAU - Wittstein, Ilan S
AU  - Wittstein IS
FAU - Judge, Daniel P
AU  - Judge DP
FAU - Champion, Hunter C
AU  - Champion HC
FAU - Barouch, Lili A
AU  - Barouch LA
FAU - Baughman, Kenneth L
AU  - Baughman KL
FAU - Russell, Stuart D
AU  - Russell SD
FAU - Kasper, Edward K
AU  - Kasper EK
FAU - Sitammagari, Kranthi K
AU  - Sitammagari KK
FAU - Hare, Joshua M
AU  - Hare JM
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PL  - Israel
TA  - Isr Med Assoc J
JT  - The Israel Medical Association journal : IMAJ
JID - 100930740
RN  - AYI8EX34EU (Creatinine)
SB  - IM
MH  - Biopsy
MH  - Cardiac Catheterization
MH  - Cardiomyopathy, Dilated/blood/*diagnosis/physiopathology
MH  - Creatinine/blood
MH  - Diagnosis, Differential
MH  - Echocardiography
MH  - Female
MH  - Follow-Up Studies
MH  - *Hemodynamics
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Myocardium/*pathology
MH  - Prognosis
MH  - Retrospective Studies
MH  - Severity of Illness Index
EDAT- 2012/12/18 06:00
MHDA- 2013/01/09 06:00
CRDT- 2012/12/18 06:00
PHST- 2012/12/18 06:00 [entrez]
PHST- 2012/12/18 06:00 [pubmed]
PHST- 2013/01/09 06:00 [medline]
PST - ppublish
SO  - Isr Med Assoc J. 2012 Nov;14(11):666-71.