Klassifikation, genetische Prädisposition und Risikofaktoren für die Entwicklung einer Kardiomyopathie

Influence of different aetiologies on clinical course and outcome in patients with dilated cardiomyopathy

BACKGROUND

The clinical phenotype dilated cardiomyopathy is assumed to be the endstage of a multifactorial aetiopathogenetic pathophysiology which includes a not satisfactorily defined group of patients with inflammatory cardiomyopathy.

METHODS

Within the German Competence Network Heart Failure patients with heart failure due to dilated cardiomyopathy of viral/inflammatory (DCMi/v) and nonviral/noninflammatory (DCM) aetiology were enrolled. After 1 year 237 patients (180 male/57 female) were re-examined including complete clinical work-up. The association of different clinical courses with the time from initial diagnosis of heart failure (newly: ≤ 1 year; late: > 1 year) was investigated.

RESULTS

After 1-year-follow-up New York Heart Association (NYHA) class (by -0.48 in newly diagnosed DCM and -0.82 in newly diagnosed DCMi/v in addition to -0.24 in late diagnosed DCM and -0.17 in late diagnosed DCMi/v) as well as left ventricular ejection fraction (+14% in newly diagnosed DCM and DCMi/v and +6% in later diagnosed DCM and DCMi/v) were significantly improved in all patients. In patients with early diagnosed dilated cardiomyopathy a strong improvement of NYHA class could be demonstrated.

CONCLUSIONS

This study demonstrates for the first time a significant interaction between duration of disease, NYHA class and left ventricular ejection fraction in patients with DCM. Our results clearly demonstrate that in patients with DCM an early diagnosis within 1 year after occurrence of clinical signs is associated with a strong improvement in the clinical course, whereas late diagnosis results in a loss of change in clinical course and outcome.

[Cardiac magnetic resonance tomography in the diagnostics of restrictive and unclassified cardiopathies]

CLINICAL/METHODICAL ISSUE

Besides ischemic heart disease cardiomyopathies are common causes of heart failure and sudden cardiac death.

STANDARD RADIOLOGICAL METHODS

The diagnostic spectrum in cardiomyopathies comprises non-invasive and invasive examination techniques.

METHODICAL INNOVATIONS

The exact verification of certain cardiomyopathies necessitates knowledge of the latest classification of cardiomyopathies as well as dedicated examination protocols.

PERFORMANCE

Modern imaging modalities, such as echocardiography and cardiac magnetic resonance imaging (MRI) have emerged as useful imaging tools in the investigation of patients suspected of having many different types of cardiomyopathies.

ACHIEVEMENTS

Based on a better understanding of the underlying pathophysiology several diagnostic criteria have been defined using cardiac MRI. In particular there is an increasing importance of cardiac MRI in the description of patients with restrictive and unclassified cardiomyopathies.

PRACTICAL RECOMMENDATIONS

Echocardiography still remains the modality of choice in the diagnostics of unclear left ventricular heart failure. Further diagnostic work-up should include cardiac MRI in case of any lack of clarity.