title: Characterization and Long-Term Prognosis of Postmyocarditic Dilated Cardiomyopathy Compared With Idiopathic Dilated Cardiomyopathy.
abstract: Dilated cardiomyopathy (DC) is the final common pathway of different pathogenetic processes and presents a significant prognostic heterogeneity, possibly related to its etiologic variety. The characterization and long-term prognosis of postmyocarditic dilated cardiomyopathy (PM-DC) remain unknown. This study assesses the clinical-instrumental evolution and long-term prognosis of a large cohort of patients with PM-DC. We analyzed 175 patients affected with DC consecutively enrolled from 1993 to 2008 with endomyocardial biopsy (EMB) data available. PM-DC was defined in the presence of borderline myocarditis at EMB or persistent left ventricular dysfunction 1 year after diagnosis of active myocarditis at EMB. Other patients were defined as affected by idiopathic dilated cardiomyopathy (IDC). Analysis of follow-up evaluations was performed at 24, 60, and 120 months. We found 72 PM-DC of 175 enrolled patients (41%). Compared with IDC, patients with PM-DC were more frequently females and less frequently presented a familial history of DC. No other baseline significant differences were found. During the long-term follow-up (median 154, first to third interquartile range 78 to 220 months), patients with PM-DC showed a trend toward slower disease progression. Globally, 18 patients with PM-DC (25%) versus 49 with IDC (48%) experienced death/heart transplantation (p = 0.045). The prognostic advantage for patients with PM-DC became significant beyond 40 months of follow-up. At multivariable time-dependent Cox analysis, PM-DC was confirmed to have a global independent protective role (hazard ratio 0.53, 95% confidence interval 0.28 to 0.97, p = 0.04). In conclusion, PM-DC is characterized by better long-term prognosis compared with IDC. An exhaustive etiologic characterization appears relevant in the prognostic assessment of DC.
authors.affiliation: Cardiovascular Department, "Ospedali Riuniti" and University of Trieste, Trieste, Italy. Electronic address: marco.merlo79@gmail.com.
authors.forename: Marco
authors.initials: M
authors.lastname: Merlo
authors.affiliation: Cardiovascular Department, "Ospedali Riuniti" and University of Trieste, Trieste, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Anzini
authors.affiliation: Institute of Pathological Anatomy and Histology, "Ospedali Riuniti" and University of Trieste, Trieste, Italy.
authors.forename: Rossana
authors.initials: R
authors.lastname: Bussani
authors.affiliation: Cardiovascular Department, "Ospedali Riuniti" and University of Trieste, Trieste, Italy.
authors.forename: Jessica
authors.initials: J
authors.lastname: Artico
authors.affiliation: Cardiovascular Department, "Ospedali Riuniti" and University of Trieste, Trieste, Italy.
authors.forename: Giulia
authors.initials: G
authors.lastname: Barbati
authors.affiliation: Cardiovascular Department, "Ospedali Riuniti" and University of Trieste, Trieste, Italy.
authors.forename: Davide
authors.initials: D
authors.lastname: Stolfo
authors.affiliation: Cardiovascular Department, "Ospedali Riuniti" and University of Trieste, Trieste, Italy.
authors.forename: Marta
authors.initials: M
authors.lastname: Gigli
authors.affiliation: Cardiovascular Department, "Ospedali Riuniti" and University of Trieste, Trieste, Italy.
authors.forename: Matilda
authors.initials: M
authors.lastname: Muça
authors.affiliation: Cardiovascular Department, "Ospedali Riuniti" and University of Trieste, Trieste, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Naso
authors.affiliation: Cardiovascular Department, "Ospedali Riuniti" and University of Trieste, Trieste, Italy.
authors.forename: Federica
authors.initials: F
authors.lastname: Ramani
authors.affiliation: Cardiovascular Center, "Azienda per i Servizi Sanitari" no. 1, Trieste, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Di Lenarda
authors.affiliation: Cardiovascular Department, "Ospedali Riuniti" and University of Trieste, Trieste, Italy.
authors.forename: Bruno
authors.initials: B
authors.lastname: Pinamonti
authors.affiliation: Cardiovascular Department, "Ospedali Riuniti" and University of Trieste, Trieste, Italy.
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Sinagra
mesh_terms: D000328:Adult; D002311:Cardiomyopathy, Dilated / Q000209:etiology* / Q000401:mortality / Q000601:surgery; D015331:Cohort Studies; D005260:Female; D016027:Heart Transplantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality; D015999:Multivariate Analysis; D009205:Myocarditis / Q000150:complications*; D011379:Prognosis; D016016:Proportional Hazards Models; D065840:Protective Factors; D012307:Risk Factors; D018487:Ventricular Dysfunction, Left / Q000209:etiology* / Q000401:mortality / Q000601:surgery