[Prognostic significance of changes in left ventricular diastolic function in follow-up of dilatative cardiomyopathy].
A total of 39 patients with idiopathic dilated cardiomyopathy (IDC) and sinus rhythm were examined for correlations between clinical course, systolic/diastolic cardiac function, and clinical status according to NYHA class (I-IV). Patients were divided in two groups: group 1 included survivors (n = 28, 49 +/- 11 years) and group 2 the nonsurvivors (n = 7) and transplanted patients (n = 4 transplanted; 48 +/- 10 years). Both groups were examined several times, and data at baseline were compared with those of the last examination. The follow-up period was about 3 years (group 1: 41 +/- 22 months, group 2: 24 +/- 13). Baseline conditions were defined at the time when the diagnosis of IDC was established. Diastolic cardiac function was evaluated by Doppler echocardiography parameters of early (VE) and late diastolic peak velocity (VA), the ratio of VE/VA and early deceleration time (EDT). Data for clinical symptoms (NYHA group 1: 2.5 +/- 0.9 vs. group 2: 2.7 +/- 1.3, NS) systolic [fractional shortening (FS) group 1: 0.17 +/- 0.06 vs. group 2: 0.16 +/- 0.06, NS], and diastolic function (VE, VA, VE/VA) showed no differences between the two groups. Only the EDT was significantly shorter in group 2 (group 1: 196 +/- 64 ms vs. group 2: 119 +/- 43 ms, P < 0.001) when diagnosis was established. During the follow-up period there was an improvement in both groups concerning NYNA class (group 1 from 2.5 +/- 0.9 to 1.9 +/- 0.7, P < 0.005; group 2 from 2.7 +/- 1.3 to 2.1 +/- 0.9, NS). There was a nonsignificant deterioration in systolic function in group 2 (FS, from 0.16 +/- 0.06 to 0.15 +/- 0.06, P = 0.07), which contrasted to an improvement in group 1 (from 0.17 +/- 0.06 to 0.20 +/- 0.08, P = 0.06). VE/VA increased in group 2 (from 1.24 to 1.67 +/- 1.21, P = 0.09) essentially due to a significantly increased VE (from 0.66 +/- 0.2 m/s to 0.85 +/- 0.27 m/s, P < 0.05). EDT remained shorter in group 2 (group 1.198 +/- 55 ms vs. 149 +/- 84 ms, P < 0.05). In conclusion, values of VE > 0.8 m/s, VE/VA > 1.6, and EDT < 150 ms during follow-up were predictors of poor prognosis in patients with IDC. Patients with a long EDT (> 150 ms) had a favorable prognosis for survival.
Georg-August-Universität Göttingen, Zentrum für Innere Medizin und Pulmonologie.
J B
JB
Fuchs
G S
GS
Werner
R
R
Schulz
H
H
Kreuzer
D000328:Adult; D000368:Aged; D001783:Blood Flow Velocity / Q000502:physiology; D002306:Cardiac Volume / Q000502:physiology; D002311:Cardiomyopathy, Dilated / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology*; D003971:Diastole / Q000502:physiology*; D015150:Echocardiography, Doppler; D015716:Electrocardiography, Ambulatory; D005260:Female; D005500:Follow-Up Studies; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000503:physiopathology; D011379:Prognosis; D013318:Stroke Volume / Q000502:physiology; D015996:Survival Rate; D016277:Ventricular Function, Left / Q000502:physiology*
Prognostische Bedeutung von Anderungen der linksventrikulären diastolischen Funktion im Erkrankungsverlauf der dilatativen Kardiomyopathie.