Prolonged QRS Duration and Severity of Mitral Regurgitation are Unfavorable Prognostic Markers of Heart Failure in Patients With Nonischemic Dilated Cardiomyopathy

Abstract

eart failure may be defined as the inability of the heart to meet the demands of the tissues, resulting in symptoms of fatigue or dyspnea on exertion progressing to dyspnea at rest. Patients with nonischemic dilated cardiomyopathy (NIDCM) constitute the largest group of myopathic disorders that are responsible for systolic heart failure. In most multicenter, randomized heart-failure trials, approximately one-third of the enrolled patients have NIDCM. The term NIDCM refers to a spectrum of heterogeneous myocardial disorders that are characterized by ventricular dilation and depressed myocardial contractility in the absence of abnormal loading conditions (such as hypertension or valvular disease) or ischemic heart disease.Angiotensin-converting enzyme inhibitors (ACEI), angiotensin receptor blockers (ARBs) and -blockers are the mainstay of treatment in patients with heart failure, irrespective of the etiology and severity of heart failure. ACEI/ARBs and -blockers have been shown to reverse left ventricular (LV) remodeling and improve dyspnea and exercise tolerance, reduce hospitalization rates, and reduce cardiovascular mortality.The prognosis of dilated cardiomyopathy (DCM) has been poor in the past, 1,2 but has improved since ACEI/ARBs Circulation Journal Vol.70, January 2006and -blockers have been widely used as treatment. Azuma et al reported that in Japan the calculated survival rate at 5 years was 90.0% in patients diagnosed with DCM after 1990 in contrast to 62.3% in patients diagnosed before 1989. 3 However, there are still some cases that remain difficult to treat despite the use of ACEI/ARBs and -blockers, and for these biventricular pacing or surgical interventions, such as heart transplantation or the Batista procedure, has been performed. Therefore, risk prediction in patients with NIDCM is crucial for selection of the best treatment strategy, but there were few reports restricted to cases of NIDCM for examining the predictive factors of heart failure.The purpose of this study was to evaluate various factors that might predict an adverse outcome in patients with NIDCM who were treated with ACEI/ARBs and/orblockers. Methods Patient SelectionWe identified 78 consecutive patients with NIDCM between 1997 and 2002. NIDCM was diagnosed by echocardiography, coronary angiography, and endomyocardial biopsy, according to the criteria proposed by the WHO/ISFC task force. NIDCM was defined as LV ejection fraction (LVEF) <0.40, a LV end-diastolic diameter (LVEDD) >55 mm on echocardiography, and the absence of significant coronary artery stenosis on angiography. Exclusion Background The goal of the present study was to identify predictors of event-free survival in nonischemic dilated cardiomyopathy (NIDCM) patients after administration of angiotensin-converting enzyme inhibitors (ACEI)/angiotensin receptor blockers (ARB) and -blockers. Methods and ResultsThe study group comprised 78 consecutive patients with NIDCM between 1997 and 2002. NIDCM was defined as ejection fraction (EF) <0.40 and left ventricular end-dias...

Electrocardiographic and cardiac magnetic resonance imaging parameters as predictors of a worse outcome in patients with idiopathic dilated cardiomyopathy

“…Amiya et al . 14 were able to show that a QRS duration of >120 ms was a significant predictor for cardiac death or hospitalization in 78 patients with non-ischaemic dilated cardiomyopathy within a follow-up period of 35.6 ± 27.8 months. Of note, non-ischaemic dilated cardiomyopathy was carefully diagnosed by echocardiography, coronary angiography, and myocardial biopsy.…”

“…4,5,14,18,19 Amiya et al . 14 also analysed CI and LVEF for prognostic impact of cardiac death or hospitalization because of deterioration of heart failure, comparable to our secondary endpoint. In our population, LVEF was a univariate predictor for the primary as well as the secondary endpoint, but failed to be predictive in multivariable analysis.…”

“…12,13 Studies on LGE behaviour in patients with IDC and their prognostic significance when compared with other CMR parameters are scarce. 12,13 Furthermore, classical prognostic parameters such as QRS duration, 4–7,14 right ventricular (RV) dilation, 15–17 or LVEF 4,5,14,18,19 have not been taken into account for prognostic impact in combination with LGE in IDC patients. However, the predictive value of any single parameter is not strong enough to assess the clinical course and outcome in an individual patient with reasonable accuracy.…”

Prediction of Short-Term Outcomes in Patients With Idiopathic Dilated Cardiomyopathy Referred for Transplantation Using Standard Echocardiography and Strain Imaging

“…Several potential prognostic markers, including gender, age, sex, etiology, left ventricular ejection fraction (LVEF), transmitral filling E/A wave ratio, E-wave deceleration time (DT), mitral and tricuspid regurgitation, pulmonary wedge pressure (PWP), peak exercise oxygen consumption (VO 2 max), levels of plasma norepinephrine, atrial and B-type natriuretic peptides (ANP, BNP), heart fatty acid binding protein (H-FABP), have been widely reported in patients with severe cardiac failure (50)(51)(52)(53)(54)(55)(56)(57)(58)(59)(60)(61)(62)(63)(64). However, the predictors of outcomes varied from study to study and in most of them long-term (>24 month) outcomes were chosen.…”

The association of QRS duration with atrial fibrillation in a heart failure with preserved ejection fraction population: a pilot study

“…9 Mechanistically, a prolonged QRSd could facilitate the onset of AF by causing ventricular dyssynchrony, which in turn can cause adverse ventricular and atrial remodeling due to a reduction in the peak rate of rise in the LV pressure, reduced diastolic filling time, and increased mitral regurgitation. 17,18 The purpose of our pilot study was to determine if QRSd is associated with AF prevalence in HFpEF.…”