ISSN: 1223-1533

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INVASIVE RISK STRATIFICATION OF PATIENTS WITH IDIOPATHIC DILATED CARDIOMYOPATHY


Authors: T. Vaikhanskaya, T. Kurushko, I. Sidorenko, L. Gul




 

Aims: the objective of this study was to investigate the prognostic value of clinical, laboratory, electrocardiographic (ECG) and echocardiographic parameters for outcome of patients (pts) with dilated cardiomyopathy (DCM).

 

Methods: the study enrolled and followed up for a mean 32,1 ±7,4 months 132 pts with DCM (72,8% male; age 49,3±11,2 years; NYHA class 3,1±0,3). Primary endpoint was time to cardiac death or heart transplantation. We analyzed age, gender, NYHA, 6-MWT, BNP, peakVO2, ejection fraction LV and RV (LVEF, RVEF), LV and RV end-diastolic and end-systolic volume/diameter, pulmonum artery pressure, virus PCR positive EMBs, 24h-Holter ECG (VT, nsVT, VF) and ECG by software Intecard-7 (HRT, mTWA, dispQT, QRSduration) at 5min rest+2min exercise test (heart rate 105±7)

 

 

Variable

Univariate analysis

Multivariate  analysis

 

RR (95%CI)

p-value

RR (95%CI)

p-value

Ventricular tachyarrythmias

2,3 (1,25-4,36)

0,011

1,24 (0,58-2,66)

0,583

QTc>460ms

2,76 (1,26-6,08)

0,013

2,3 (0.89-5,94)

0,085

QRS>120ms

2,42 (1,17-4,93)

0,018

1,61 (0.70-3.72)

0,265

QTdispersion>75ms

2,47 (1,19-5,16)

0,017

1,13 (0,45-2,89)

0,810

mTWA>45mcV

2,84 (1,23-5,89)

0,012

1,56 (0,78-3,56)

0,312

PeakVO2<15ml/kg/min

3,43 (1,79-6,13)

<0,001

3,02 (1,78-9,21)

0,012

Biventricular depression EF

3,87 (1,81-6,95)

<0,001

3,21 (1,29-8,22)

0,013

 

Table 78.1. Relative risk, ratio (RR) for the primary endpoint

 

Results: On univariate analysis, ventricular tachyarrythmias (VT/nsVT/VF), QTc>460ms and QRS>120ms, QT dispersion>75ms, positive mTWA, peak VO2<15ml/kg/min, biventricular depressionEF were significantly associated with endpoint (tab1). Other parameters, like NYHA, 6-MWT, BNP, atrial arrhythmias, HRT, dimension LV and RV, virus PCR positive EMBs were not significantly related to the primary endpoint.

On multivariate analysis, only biventricular depression (EFLV :20%; EFRV:35%) and peak VO2<15ml/kg/min remained significant and were as independent predictors of poor outcome. For risk stratification, RR of the independent predictors and their combinations for the primary endpoint was 6,78 (95% CI 3,12-14,9; p<0,001)

 

Conclusion: Biventricular decrease EF and peak VO2<15ml/kg/min are an independent predictors for cardiac death or heart transplantation of pts with DCM.