Impact of myocardial perfusion abnormality on prognosis in patients with non-ischemic dilated cardiomyopathy.
BACKGROUND
Myocardial perfusion imaging shows various patterns in patients with non-ischemic dilated cardiomyopathy (DCM). However, influences of regional abnormalities of myocardial perfusion or ventricular wall motion on prognosis in DCM patients remains to be clarified. Accordingly, we investigated a relation between myocardial perfusion patterns and long-term prognosis in DCM patients.


RESULTS
Sixty-two patients were divided into 2 groups according to patterns of (99m)Tc-Tetrofosmin scintigraphy, i.e. large focal defects (focal) and minimally impaired perfusion or multiple small defects (non-focal). There were no differences between the 2 groups in left ventricular (LV) end-diastolic dimensions (63.4 ± 9.1 and 63.8.4 ± 7.5mm, respectively) and LV ejection fraction (30.3 ± 9.2 and 27.9 ± 7.8%, respectively), indicating LV systolic dysfunction was comparable between the groups. The focal group had a higher prevalence of brain natriuretic peptide ≧ 200 ng/dl and plasma norepinephrine ≧ 500 pg/ml than the non-focal group (p<0.05), and had longer QRS durations (p<0.05). The focal group had non-sustained ventricular tachycardia (VT) (p<0.05) on 24-h electrocardiogram recording and a history of VT/ventricular fibrillation more frequently (p<0.05), and had higher New York Heart Association functional class than the non-focal group (p<0.05). The mortality was significantly higher in the focal group (56.0%) than in the non-focal group (28.6%) and the survival curves revealed worse prognosis in the focal group during a follow-up period of 5.3 ± 2.8 years.


CONCLUSIONS
Non-ischemic DCM patients with focal defects are accompanied by more advanced heart failure and poor prognosis compared to those with minimally impaired perfusion or multiple small defects, despite comparable LV systolic dysfunction.
Sobajima
Mitsuo
M
The Second Department of Internal Medicine, Graduate School of Medicine, University of Toyama, 2630 Sugitani, Toyama 930-0194, Japan.
Nozawa
Takashi
T
Suzuki
Takayuki
T
Ohori
Takashi
T
Shida
Takuya
T
Matsuki
Akira
A
Inoue
Hiroshi
H
D000328:Adult; D000368:Aged; D002311:Cardiomyopathy, Dilated / Q000000981:diagnostic imaging* / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging; D011379:Prognosis; D012189:Retrospective Studies