The spectrum of left ventricular size in dilated cardiomyopathy: Clinical correlates and prognostic implications

Gayazzi, Antonello; Maria, Renata De; G, Renosto; Moro, A. Zúñiga; Borgia, M C; Caroli, Angelo; Castelli, Gabriele; Ciaccheri, M; Pavan, Daniela; Vita, Claudio; Baroldi, G; Camerini, F

doi:10.1016/0002-8703(93)90020-a

Cited by 80 publications

(66 citation statements)

References 25 publications

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“…6 Gavazzi et al studied 144 patients with DCM to determine the variability and prognostic importance of LV dilatation and reported that mild dilatation was not uncommon (31% of patients with DCM). 8 These patients are a heterogeneous group that includes some in the early stages of the disease and others with severe LV dysfunction and minimal dilatation. However, those earlier reports have several limitations, such as the relatively short follow-up period (from 20 to 30 months) and the infrequent use of ACEI and -blockers.…”

Section: Previous Studies Of Ventricular Dilatation and Prognosis In mentioning

confidence: 99%

“…1 Although the degree of LV dilatation is generally thought to be one of the predictors of poor outcome, 2-5 several investigators have reported that the prognosis of patients with mild LV dilatation (MDCM) is variable. [6][7][8] However, the long-term prognosis and changes in the echocardiographic parameters of such patients are unknown and so we aimed to elucidate the long-term prognosis and predictive factors in patients with MDCM. …”

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Long-Term Prognosis of Patients With Mildly Dilated Cardiomyopathy.

Kitaoka

Matsumura

Yamasaki

et al. 2002

Circ J

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eft ventricular (LV) dilatation and systolic dysfunction are the hallmarks of idiopathic dilated cardiomyopathy (DCM). 1 Although the degree of LV dilatation is generally thought to be one of the predictors of poor outcome, 2-5 several investigators have reported that the prognosis of patients with mild LV dilatation (MDCM) is variable. [6][7][8] However, the long-term prognosis and changes in the echocardiographic parameters of such patients are unknown and so we aimed to elucidate the long-term prognosis and predictive factors in patients with MDCM. Methods PatientsA careful history was obtained from all patients, who also underwent physical examination, routine blood tests, chest radiography, standard ECG, exercise stress testing, echocardiography, and right-and left-heart cardiac catheterization with coronary angiography and left ventriculography. DCM was diagnosed based on exclusion of other causes of LV dysfunction, such as acute myocarditis, significant coronary artery stenosis, valvular disease and/or other secondary myocardial diseases. MDCM was defined by (1) a LV ejection fraction (LVEF) ≤40% with a LV end-diastolic volume ≤120 ml/m 2 on left ventriculography and (2) the absence of a dip-and-plateau right ventricular pressure caused by a restrictive cardiomyopathy. 9 Therefore, of 144 consecutive patients with DCM, 21 (15%) were diagnosed with MDCM.

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Section: Previous Studies Of Ventricular Dilatation and Prognosis In mentioning

confidence: 99%

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Long-Term Prognosis of Patients With Mildly Dilated Cardiomyopathy.

Kitaoka

Matsumura

Yamasaki

et al. 2002

Circ J

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“…12,19) On the other hand, several investigators have reported that the prognosis of DCM patients with mild LV dilatation is variable and that end-stage heart failure occurs in a subgroup of patients with DCM despite mild LV dilatation. [20][21][22][23] We previously reported that DCM patients with mild LV dilatation have two important features: one group of patients with early and mild DCM may stabilize or improve through the natural course or with appropriate medi- 71.0 ± 20.6 (n = 5) 64.5 ± 20.6 (n = 15) 0.546 E/Ea septal 12.0 ± 3.3 (n = 2) 15.9 ± 7.0 (n = 7) 0.479 Laboratory data BNP, pg/mL 700.1 ± 532.5 (n = 3) 328.5 ± 307.1 (n = 10) 0.144 Creatinine, mg/dL 1.03 ± 0.49 (n = 3) 0.93 ± 0.16 (n = 10) 0.753 Sodium, mmol/L 140.7 ± 3.2 (n = 3) 139.9 ± 2.5 (n = 11) 0.667 Total bilirubin, mg/dL 1.30 ± 1.13 (n = 2) 0.72 ± 0.22 (n = 11) 0.599…”

Section: Discussionmentioning

confidence: 99%

Prognostic Significance of Non-Dilated Left Ventricular Size and Mitral Regurgitation in Patients With Dilated Phase of Hypertrophic Cardiomyopathy

et al. 2017

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SummaryAlthough a subtype of hypertrophic cardiomyopathy (HCM), dilated phase of HCM (D-HCM) characterized by left ventricular (LV) systolic dysfunction, has been reported to have a poor prognosis, some patients with D-HCM survive for a relatively long period. The degree of LV dilatation and functional mitral regurgitation (MR) are generally thought to be important predictors of poor prognosis in patients with LV systolic dysfunction. However, there is little information available on the relations among LV size, presence of significant MR, and prognosis in D-HCM patients.We retrospectively studied 31 patients with D-HCM to determine whether echocardiographic assessment of LV size and MR provides incremental prognostic information.During a follow-up period of 5.6 ± 4.2 years, there were 13 cardiovascular deaths. When the patients were divided into two groups by LV size at diagnosis of D-HCM, a non-dilated LV group (LV end-diastolic diameter (LVEDD) < 50 mm, n = 9) and a dilated LV group (LVEDD ≥ 50 mm, n = 22), the clinical course in the non-dilated LV group was significantly worse. As for the clinical impact of MR, no patient in the non-dilated LV group showed significant MR and 7 of the patients with dilated LV size showed significant MR during follow-up. Once significant MR was reached, cardiovascular deaths were significantly more frequent in patients with MR.Patients with D-HCM, particularly those with less LV dilatation at diagnosis of dilated phase and with significant MR during follow-up, have a poor prognosis. (Int Heart J 2017; 58: 63-68)

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“…Before the advent of anti-remodeling medications, Gravazzi et al reported that PCWP and the LAd index were significant predictors of prognosis in NIDCM patients. 11 But since then there have been few reports about the predictive factors of heart failure in NIDCM patients after administration of these medications.…”

Section: Discussionmentioning

confidence: 99%

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

Amiya

Tanabe

Ikari

et al. 2006

Circ J

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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...

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The spectrum of left ventricular size in dilated cardiomyopathy: Clinical correlates and prognostic implications

Cited by 80 publications

References 25 publications

Long-Term Prognosis of Patients With Mildly Dilated Cardiomyopathy.

Long-Term Prognosis of Patients With Mildly Dilated Cardiomyopathy.

Prognostic Significance of Non-Dilated Left Ventricular Size and Mitral Regurgitation in Patients With Dilated Phase of Hypertrophic Cardiomyopathy

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

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