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Contemporary survival trends and aetiological characterization in non‐ischaemic dilated cardiomyopathy
Author(s) -
Merlo Marco,
Cannatà Antonio,
Pio Loco Carola,
Stolfo Davide,
Barbati Giulia,
Artico Jessica,
Gentile Piero,
De Paris Valerio,
Ramani Federica,
Zecchin Massimo,
Gigli Marta,
Pinamonti Bruno,
Korcova Renata,
Di Lenarda Andrea,
Giacca Mauro,
Mestroni Luisa,
Camici Paolo G.,
Sinagra Gianfranco
Publication year - 2020
Publication title -
european journal of heart failure
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.149
H-Index - 133
eISSN - 1879-0844
pISSN - 1388-9842
DOI - 10.1002/ejhf.1914
Subject(s) - medicine , dilated cardiomyopathy , etiology , heart failure , cardiology , heart transplantation , cardiomyopathy , incidence (geometry) , transplantation , sudden cardiac death , physics , optics
Aim Contemporary survival trends in dilated cardiomyopathy (DCM) are largely unknown. The aim of this study is to investigate clinical descriptors, survival trends and the prognostic impact of aetiological characterization in DCM patients. Methods and results Dilated cardiomyopathy patients were consecutively enrolled and divided into four groups according to the period of enrolment (1978–1984; 1985–1994; 1995–2004; and 2005–2015). A subset of patients with DCM of specific aetiology, enrolled from 2005 to 2015, was also analysed. Over a mean follow‐up of 12 ± 8 years, 1284 DCM patients (52 in the 1978–1984 group, 326 in the 1985–1994 group, 379 in the 1995–2004 group, and 527 in the 2005–2015 group) were evaluated. Despite older age (mean age 51 ± 15, 43 ± 15, 45 ± 14, and 52 ± 15 years for the 1978–1984, 1985–1994, 1995–2004, and 2005–2015 groups, respectively; P < 0.001), most of the baseline clinical characteristics improved in the 2005–2015 group, suggesting a less advanced disease stage at diagnosis. Similarly, at competing risk analysis, the annual incidence of all outcome parameters progressively decreased over time (global P < 0.001). At multivariable analysis, the last period of enrolment emerged as independently associated with a reduction in all‐cause mortality/heart transplantation (HTx)/ventricular assist device (VAD) implantation (1.46 events/100 patients/year), cardiovascular death/HTx/VAD implantation (0.82 events/100 patients/year) and sudden cardiac death (0.15 events/100 patients/year). Lastly, in 287 patients with DCM of specific aetiology, patients with environmental, toxic, or removable factors appeared to have different phenotypes and prognosis compared to those with genetic, post‐myocarditis, or idiopathic DCM ( P < 0.001). Conclusions Contemporary survival trends in DCM significantly improved, mainly due to a reduction of cardiovascular events. Appropriate aetiological characterization might help in prognostication of DCM patients.