Premium
Prognostic value of serial cardiac assessment and familial screening in patients with dilated cardiomyopathy
Author(s) -
Grünig Ekkehard,
Benz Andreas,
Mereles Derliz,
Unnebrink Kristina,
Kücherer Helmut,
Haass Markus,
Kübler Wolfgang,
Katus Hugo A.
Publication year - 2003
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 - 10.1016/s1388-9842(02)00179-4
Subject(s) - medicine , cardiology , ejection fraction , heart failure , dilated cardiomyopathy , left bundle branch block , prospective cohort study , diastole , physical examination , blood pressure
Objectives: This prospective study was performed to analyse whether routine clinical follow‐up investigations at 12±6 months add to risk stratification and improve survival rates in patients with a first diagnosis of dilated cardiomyopathy (DCM). Methods: Four hundred and eighty consecutive patients (mean age 53.4±12.3 years, 369 males, mean NYHA class 2.4±0.8) with invasively confirmed DCM were included and followed for 3.9±3.5 years. Patients were requested to adhere to a follow up investigation within 6–18 months either at the referring physicians or at our out patient department. Two hundred and eighty‐one of the 480 patients presented for follow up which consisted of a detailed evaluation of symptoms, standardized physical examination, 12‐lead‐electrocardiogram recording and echocardiography. Seventeen patients were lost for follow up, 182 did not seek specialized medical follow up. Patients outcome was assessed by structured telephone interviews. Results: Independent predictors of death or transplantation at initial diagnosis were LV–ejection fraction <30% ( P =0.0001, risk ratio 2.25), LV–end diastolic pressure ≥15 mmHg ( P =0.002, risk ratio 2.0), age ≥54 years, ( P =0.04, risk ratio 1.55), and presence of left bundle branch block ( P =0.046, risk ratio 1.53). On follow up investigations only deterioration of clinical status by at least one NYHA‐class ( P =0.001, risk ratio 2.6) and new onset or worsening of mitral regurgitation ( P =0.02, risk ratio 1.8), remained independent prognostic factors for cardiac death. Patients who presented for routine follow up revealed significant better 5‐year survival rates ( n =281, 70%) than those who did not ( n =153, 55%, P =0.005). Conclusions: Routine clinical follow up investigations within 6–18 months after first diagnosis of DCM adds to risk stratification and improves survival rates.