ASSESSMENT OF THE APPROPRIATENESS OF THE DECISION OF HEART-TRANSPLANTATION IN IDIOPATHIC-DILATED CARDIOMYOPATHY

One hundred thirty patients with idiopathic-dilated cardiomyopathy wer e referred for heart transplantation to our center and followed for 18 months. Heart transplantation was performed on 63 patients, 17 patien ts died before transplantation due to heart failure, and 50 patients n ever had transplantation. Clinical, electrocardiographic, echocardiogr aphic, and hemodynamic data of the 50 nontransplanted survivors and th e 17 patients who died were used to identify independent risk variable s with discriminant analysis. Using a statistical model based on the r esults of discriminant analysis, each of the remaining 63 transplanted patients were predicted as being alive or dead in absence of transpla ntation. The discriminant analysis identified right atrial pressure, c ardiac index, and the New York Heart Association functional class as t he strongest predictors of 18-month outcome, The accuracy of the model in predicting survival without transplantation in the nontransplanted group of patients, based on the concordance between actual and predic ted outcome, was 85% (kappa = 0.62). Subsequent application of this mo del to the transplanted group of patients suggested that the decision for transplantation was appropriate in 41 of the 63 patients, and coul d have been premature in the remaining 22 patients predicted as alive. These results suggest that two-thirds of patients receiving transplan ts would have died without intervention, but the decision to transplan t could have been premature in the remaining patients. (C) 1997 by Exc erpta Medica, Inc.