PMID- 9761090
OWN - NLM
STAT- MEDLINE
DCOM- 19981020
LR  - 20190622
IS  - 0002-9149 (Print)
IS  - 0002-9149 (Linking)
VI  - 82
IP  - 6
DP  - 1998 Sep 15
TI  - Risk stratification in patients with dilated cardiomyopathy: contribution of 
      Doppler-derived left ventricular filling.
PG  - 779-85
AB  - Dilated cardiomyopathy (DCM) is a major cause of mortality among patients with 
      heart failure. The aim of the present study was to investigate the independent 
      contribution of Doppler-derived left ventricular (LV) filling to the prediction 
      of survival in patients with DCM, of either ischemic or nonischemic origin, and 
      to derive a simple risk stratification score based on easily available clinical 
      and echocardiographic parameters. We followed 197 consecutive patients (159 men, 
      mean age 60+/-13 years) with an echocardiographic diagnosis of DCM (LV 
      end-diastolic dimension >60 mm, fractional shortening <25%) over an average 
      period of 62+/-13 months. The presumed etiology of DCM was ischemic in 52% of the 
      patients. During follow up, 69 patients died of cardiac causes and 41 required 
      transplantation. At 5 years, overall cardiac event-free survival was 55% and 
      freedom from death or heart transplantation was 43% (compared with 86% for the 
      5-year age- and sex-adjusted survival rate in our country). Kaplan-Meier survival 
      curves generated for different thresholds of the peak E velocity and the E/A 
      ratio indicated significant worsening of prognosis with increasing values of 
      these parameters in both ischemic and nonischemic patients. Using Cox stepwise 
      regression analyses, age (chi-square to remove 24.4; p <0.001), peak E velocity 
      (chi-square to remove=18.9; p <0.001), LV ejection fraction (chi-square to remove 
      6.4; p <0.011), and systolic blood pressure (chi-square to remove 4.5; p=0.034) 
      independently predicted cardiac deaths, whereas New York Heart Association (NYHA) 
      functional class (chi-square to remove 48.5; p < 0.001), LV ejection fraction 
      (chi-square to remove 19.1; p <0.001), E/A ratio (chi-square to remove 10.8; p 
      <0.001), and systolic blood pressure (chi-square to remove 5.8; p <0.016) were 
      independently associated with cardiac death or need for transplantation. Based on 
      these parameters, a risk score was elaborated, which allowed appropriate 
      classification of each individual patient into low- (5-year survival rate of 
      72%), intermediate- (46% survival rate), and high-risk groups (11% survival 
      rate). In conclusion, our data show that among the noninvasive parameters 
      commonly available in patients with either ischemic or nonischemic DCM, age, the 
      NYHA functional class, the LV ejection fraction, the systolic blood pressure, the 
      peak E velocity, and the E/A ratio provide relevant and independent information 
      regarding the risk of cardiac death or the need for heart transplantation.
FAU - Lapu-Bula, R
AU  - Lapu-Bula R
AD  - Division of Cardiology, University of Louvain Medical School, Brussels, Belgium.
FAU - Robert, A
AU  - Robert A
FAU - De Kock, M
AU  - De Kock M
FAU - D'Hondt, A M
AU  - D'Hondt AM
FAU - Detry, J M
AU  - Detry JM
FAU - Melin, J A
AU  - Melin JA
FAU - Vanoverschelde, J L
AU  - Vanoverschelde JL
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PL  - United States
TA  - Am J Cardiol
JT  - The American journal of cardiology
JID - 0207277
SB  - IM
MH  - Cardiomyopathy, Dilated/mortality/*physiopathology/surgery
MH  - Death
MH  - *Echocardiography, Doppler
MH  - Female
MH  - Follow-Up Studies
MH  - Heart Transplantation
MH  - Heart Ventricles/*diagnostic imaging/physiopathology
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Prognosis
MH  - Retrospective Studies
MH  - Risk Assessment
MH  - Stroke Volume
MH  - Survival Rate
MH  - Ventricular Dysfunction, Left/mortality/*physiopathology/surgery
EDAT- 1998/10/07 00:00
MHDA- 1998/10/07 00:01
CRDT- 1998/10/07 00:00
PHST- 1998/10/07 00:00 [pubmed]
PHST- 1998/10/07 00:01 [medline]
PHST- 1998/10/07 00:00 [entrez]
AID - S0002914998004603 [pii]
AID - 10.1016/s0002-9149(98)00460-3 [doi]
PST - ppublish
SO  - Am J Cardiol. 1998 Sep 15;82(6):779-85. doi: 10.1016/s0002-9149(98)00460-3.