RISK STRATIFICATION IN PATIENTS WITH DILATED CARDIOMYOPATHY - CONTRIBUTION OF DOPPLER-DERIVED LEFT-VENTRICULAR FILLING

Dilated cardiomyopathy (DCM) is a major cause of mortality among patie nts with heart failure. The aim of the present study was to investigat e the independent contribution of Doppler-derived left ventricular (LV ) filling to the prediction of survival in patients with DCM, of eithe r ischemic or nonischemic origin, and to derive a simple risk stratifi cation score based on easily available clinical and echocardiographic parameters. We followed 197 consecutive patients (159 men, mean age 60 +/- 13 years) with an echocardiographic diagnosis of DCM (LV end-dias tolic dimension >60 mm, fractional shortening <25%) over an average pe riod of 62 +/- 13 months. The presumed etiology of DCM was ischemic in 52% of the patients. During follow up, 69 patients died of cardiac ca uses and 41 required transplantation. At 5 years, overall cardiac even t-free survival was 55% and freedom from death or heart transplantatio n was 43% (compared with 86% for the 5-year age- and sex-adjusted surv ival rate in our country). Kaplan-Meier survival curves generated for different thresholds of the peak E velocity and the E/A ratio indicate d significant worsening of prognosis with increasing values of these p arameters in both ischemic and nonischemic patients. Using Cox stepwis e regression analyses, age (chi-square to remove 24.4; p < 0.001), pea k E velocity (chi-square to remove 18.9; p < 0.001) LV ejection fracti on (chi-square to remove 6.4; p < 0.011), and systolic blood pressure (chi-square to remove 4.5; p = 0.034) independently predicted cardiac deaths, whereas New York Heart Association (NYHA) functional class (ch i-square to remove 48.5; p < 0.001), LV ejection fraction (chi-square to remove 19.1; p < 0.001), E/A ratio (chi-square to remove 10.8; p < 0.001), and systolic blood pressure (chi-square to remove 5.8; p < 0.0 16) were independently associated with cardiac death or need for trans plantation. Based on these parameters, a risk score was elaborated, wh ich allowed appropriate classification of each individual patient into low- (5-year survival rate of 72%), intermediate- (46% survival rate) , and high-risk groups (11% survival rate). In conclusion, our data sh ow that among the noninvasive parameters commonly available in patient s with either ischemic or nonischemic DCM, age, the NYHA functional cl ass, the LV ejection fraction, the systolic blood pressure, the peak 8 velocity, and the E/A ratio provide relevant and independent informat ion regarding the risk of cardiac death or the need for heart transpla ntation. (C) 1998 by Excerpta Medica, Inc.