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Outcome predictors in dilated cardiomyopathy or myocarditis
Author(s) -
Kuethe Friedhelm,
Franz Marcus,
Jung Christian,
Porrmann Christiane,
Reinbothe Franziska,
Schlattmann Peter,
Egerer Renate,
Mall Gerhard
Publication year - 2017
Publication title -
european journal of clinical investigation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.164
H-Index - 107
eISSN - 1365-2362
pISSN - 0014-2972
DOI - 10.1111/eci.12772
Subject(s) - medicine , hazard ratio , ejection fraction , histopathology , myocarditis , cardiology , heart failure , dilated cardiomyopathy , cardiomyopathy , pathology , confidence interval
Background The objective of this study was to identify parameters of prognostic relevance in patients presenting with chronic left ventricular dysfunction who underwent endomyocardial biopsy. Materials and methods A total of 351 consecutive patients (age 47·7 ± 12·6 years, 281 male) with a chronic left ventricular dysfunction were enrolled. Endomyocardial biopsies were analysed by histopathology according to Dallas criteria and immunohistological WHO criteria. Virus genome was detected by polymerase chain reaction. The combined end point was time to death or heart transplantation. Results About 19% of patients ( n = 67) showed positive Dallas criteria and 39% ( n = 118) immunohistochemical signs of inflammation. Viral genome was present in 58% ( n = 155). During follow‐up, 25% ( n = 89; 76 death, 13 HTx) reached the end point. Dallas‐positive histopathology (hazard ratio: 0·42; 95% CI: 0·29–0·84, P = 0·031), ejection fraction (hazard ratio: 0·97; 95% CI: 0·94–0·99, P = 0·019) and β‐blocker therapy (hazard ratio: 0·41; 95% CI: 0·23–0·69, P = 0·003) were independent outcome predictors. For patients under β‐blocker therapy, Dallas‐positive histopathology (hazard ratio: 0·37; 95% CI: 0·25–0·76, P = 0·009) and NYHA class III and class IV (hazard ratio: 2·11; 95% CI: 1·04–3·12, P = 0·006) were independent predictors. Conclusions For patients with a chronic left ventricular dysfunction, Dallas‐positive histopathology, β‐blocker therapy and left ventricular ejection fraction are the most striking parameters for outcome prediction.