Outcome and prognostic value of N‐terminal pro‐brain natriuretic peptide and high‐sensitivity C‐reactive protein in mildly dilated cardiomyopathy vs. dilated cardiomyopathy

Feng, Jiayu; Tian, Pengchao; Liang, Lin; Chen, Yu-Yi; Wang, Yunlong; Zhai, Mei; Huang, Yan; Zhou, Qiong; Zhao, Xuemei; Zhao, Lang; Huang, Boping; Huang, Liyan; Zhang, Yuhui; Zhang, Jiän

doi:10.1002/ehf2.13864

Cited by 9 publications

(11 citation statements)

References 22 publications

(46 reference statements)

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“…We report the rather unexpected finding that there are equal survival rates in both DCM and HNDC groups, along with comparable free-CV death survival, and event-free survival (including all-cause mortality, HTX, and LVAD implantation). To the best of our knowledge, there are only two studies focused on this issue with >100 patients: those by Feng et al [16] and Gigli et al [17]. Importantly, both authors did not even use the ESC-endorsed term of HNDC, but instead used “mildly dilated cardiomyopathy.” According to these studies, HNDC patients had a better prognosis than DCM.…”

Section: Discussionmentioning

confidence: 99%

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Comparison of Clinical Course and Outcomes between Dilated and Hypokinetic Non-Dilated Cardiomyopathy

Dziewięcka¹,

Winiarczyk²,

Wiśniowska‐Śmiałek³

et al. 2023

Cardiology

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Background: By definition, dilated cardiomyopathy (DCM) is characterized by enlargement of the left ventricular (LV) cavity, and systolic dysfunction. However, in 2016 ESC introduced a new clinical entity – hypokinetic non-dilated cardiomyopathy (HNDC). HNDC is defined as LV systolic dysfunction without LV dilatation. However, the diagnosis of HNDC has so far rarely been made by a cardiologist, and it is unknown whether “classic” DCM differs from HNDC in terms of clinical course and outcomes. Objectives: Comparison of heart failure profiles and outcomes between patients with “classic” dilated (DCM) and hypokinetic non-dilated cardiomyopathies (HNDC). Method: We retrospectively analysed 785 DCM patients, defined as impaired left ventricle (LV) systolic function (ejection fraction [LVEF] <45%) in the absence of coronary artery disease, valve disease, congenital heart disease and severe arterial hypertension. “Classic” DCM was diagnosed when LV dilatation was present (LV end-diastolic diameter >52mm/58mm in women/men); otherwise, HNDC was diagnosed. After 47±31 months, the all-cause mortality and composite endpoint (all-cause mortality, heart transplant – HTX, left ventricle assist device implantation - LVAD) were assessed. Results: There were 617 (79%) patients with LV dilatation. Patients with “classic” DCM differed from HNDC in terms of clinically relevant parameters [hypertension (47% vs. 64%, p=0.008), ventricular tachyarrhythmias (29% vs. 15%, p=0.007), NYHA class (2.5±0.9 vs. 2.2±0.8, p=0.003), had lower cholesterol (LDL: 2.9±1.0 vs. 3.2±1.1mmol/l, p=0.049) and higher NT-proBNP (3351±5415 vs. 2563±8584pg/ml, p=0.0001); and required higher diuretics dosages (57.8±89.5 vs. 33.7±48.7mg/day, p=<0.0001). All of their chambers were larger (LVEDd: 68.3±4.5 vs. 52.7±3.5mm, p<0.0001) and they had lower LVEF (25.2±9.4 vs. 36.6±11.7%, p<0.0001). During the follow-up, there were 145 (18%) composite endpoints (“classic” DCM vs. HNDC: 122 [20%] vs. 26 [18%], p=0.22): deaths (97 [16%] vs. 24 [14%], p=0.67), HTX (17 [4%] vs. 4 [4%], p=0.97) and LVAD (19 [5%] vs 0 [0%], p=0.03). Both groups did not differ in terms of all-cause mortality (p=0.70), CV mortality (p=0.37) and composite endpoint (p=0.26). Conclusions: LV dilatation was absent in more than one-fifth of DCM patients. HNDC patients had less severe HF symptoms, less advanced cardiac remodelling, and required lower diuretics dosages. On the other hand, “classic” DCM and HNDC patients did not differ in terms of all-cause mortality, CV mortality and composite endpoint.

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Section: Discussionmentioning

confidence: 99%

“…[16] more than 30% did not receive renin-angiotensinaldosterone system inhibitors [16,17]. At present, it is very difficult to provide a clear explanation of this intriguing finding.…”

Section: Outcomes In Dcm and Hndcmentioning

confidence: 99%

Comparison of Clinical Course and Outcomes between Dilated and Hypokinetic Non-Dilated Cardiomyopathy

Dziewięcka¹,

Winiarczyk²,

Wiśniowska‐Śmiałek³

et al. 2023

Cardiology

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“…The protective effect of higher SBP was consistent with previous studies [ 42 , 43 ], and the underlying mechanism may be that patients with higher SBP had better tissue perfusion and cardiac function. Meanwhile, NT-proBNP consistently presented prognostic value that cannot be ignored [ 44 ]. The negative effect of LVEDD in this study was not surprising, since it had been demonstrated that expansion of LVEDD increased the risk of HF and sudden cardiac death [ 45 , 46 ].…”

Section: Discussionmentioning

confidence: 99%

Prognostic potential of liver injury in patients with dilated cardiomyopathy: a retrospective study

et al. 2022

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Background Liver injury (LI) has been frequently observed in patients with dilated cardiomyopathy (DCM), whereas its prognostic value remains blurry. We attempted to appraise the prognostic effect of LI in patients with DCM. Methods This retrospective study included 523 patients with DCM. LI was defined as a threefold increase in aspartate transaminase (≥ 135 U/L) or alanine transaminase (≥ 180 U/L) or a twofold increase in total bilirubin (≥ 41 umol/L) during hospitalization. The population was segmented into non-liver injury (NLI) group and LI group based on liver function test data. To balance differences in covariates at baseline, 1:1 propensity score matching (PSM) was performed. Results Patients with LI had lower survival rate, compared with those with NLI (44.6% vs. 73.8%, P < 0.001). Similar results were also found in age (age > 50, 39.6% vs. 70.9%, P < 0.001; age ≤ 50, 51.3% vs. 79.5%, P < 0.001) and gender stratified analysis (male, 46.2% vs. 74.4%, P < 0.001; female 35.7% vs. 72.0%, P = 0.001). After PSM, the survival rate of patients with LI remained lower than those with NLI (44.6% vs. 64.1%, P = 0.019). Multivariable Cox regression analysis manifested that LI (hazard ratio [HR]: 1.692, 95% confidence interval [CI] 1.194–2.398, P = 0.003; HR: 1.675, 95% CI 1.078–2.604, P = 0.022, respectively) showed potent predictive effect on all-cause mortality in patients with DCM, both before and after PSM. Conclusions The occurrence of LI herald adverse outcomes in patients with DCM and attention to LI may be conducive to risk stratification and management.

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“…Univariate and multivariate Cox proportional hazards regression were used to evaluate the association of baseline remnant cholesterol levels with time to all-cause mortality. According to our previous studies and guidelines, the selected potential confounders in the multivariable analysis were sex, age, BMI, hypertension, diabetes mellitus, CAD, heart rate, SBP, DBP, hemoglobin, ALB, ALT, AST, TBIL, serum uric, eGFR, hsCRP, logNT-proBNP, LVEF, New York Heart Association (NYHA) Functional Class and pharmacotherapy ( 1 , 10 , 15 – 18 ). Smooth curve fitting with full adjustment of the covariates was employed to explore the dose–response relationship between remnant cholesterol and the risk of all-cause mortality.…”

Section: Methodsmentioning

confidence: 99%

Predictive value of remnant cholesterol level for all-cause mortality in heart failure patients

Zhao

Tian

et al. 2023

Front. Cardiovasc. Med.

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BackgroundLower cholesterol levels are associated with increased mortality in heart failure (HF) patients. Remnant cholesterol corresponds to all cholesterol not found in high-density lipoprotein (HDL) and low-density lipoprotein (LDL). The prognostic role of remnant cholesterol in HF remains unknown.ObjectiveTo reveal the relationship between the baseline remnant cholesterol level and all-cause mortality in HF patients.MethodsThis study enrolled 2,823 patients hospitalized for HF. Kaplan–Meier analysis, Cox regression, C-statistic, net reclassification improvement (NRI), and integrated discrimination improvement (IDI) were used to evaluate the prognostic value of remnant cholesterol for all-cause mortality in HF.ResultsThe mortality rate was lowest in the fourth quartile of remnant cholesterol, which had an adjusted hazard ratio (HR) for death of 0.56 [HR: 0.39, 95% confidence interval (CI): 0.46–0.68, p < 0.001] relative to the first quartile. After adjustment, a one-unit increase in the level of remnant cholesterol was associated with a 41% decrease in the risk of all-cause mortality (HR: 0.59, 95% CI: 0.47–0.73, p < 0.001). A refinement in risk prediction was observed after adding remnant cholesterol quartile to the original model (ΔC-statistic = 0.010, 95% CI: 0.003–0.017; NRI = 0.036, 95% CI: 0.003–0.070; IDI = 0.025, 95% CI: 0.018–0.033; all p < 0.05).ConclusionLow remnant cholesterol levels are associated with increased all-cause mortality in HF patients. The addition of the remnant cholesterol quartile improved the predictive value over traditional risk factors.Clinical Trial RegistrationClinicalTrials.gov, Unique Identifier: NCT02664818.

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Outcome and prognostic value of N‐terminal pro‐brain natriuretic peptide and high‐sensitivity C‐reactive protein in mildly dilated cardiomyopathy vs. dilated cardiomyopathy

Cited by 9 publications

References 22 publications

Comparison of Clinical Course and Outcomes between Dilated and Hypokinetic Non-Dilated Cardiomyopathy

Comparison of Clinical Course and Outcomes between Dilated and Hypokinetic Non-Dilated Cardiomyopathy

Prognostic potential of liver injury in patients with dilated cardiomyopathy: a retrospective study

Predictive value of remnant cholesterol level for all-cause mortality in heart failure patients

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