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Cesareo M, Ródenas-Alesina E, Guala A, Lozano-Torres J, Casas G, Vallelonga F, Airale L, Ferreira-González I, Milan A, Rodriguez-Palomares JF. Echocardiography-Derived Hemodynamic Forces Are Associated with Clinical Outcomes in Patients with Non-Ischemic Dilated Cardiomyopathy. J Clin Med 2024; 13:3862. [PMID: 38999432 PMCID: PMC11242817 DOI: 10.3390/jcm13133862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Revised: 06/20/2024] [Accepted: 06/25/2024] [Indexed: 07/14/2024] Open
Abstract
Introduction: Non-ischemic dilated cardiomyopathy (NIDCM) is characterized by a reduced left ventricular (LV) ejection fraction (LVEF, <50%) and a high risk for heart failure (HF) and death. Echocardiography-derived hemodynamic forces (HDFs) may provide important information on LV mechanics, but their prognostic value is unknown. Aim: To explore the features of echocardiography-derived HDFs in NIDCM and their association with clinical endpoints. Methods: Asymptomatic, non-hospitalized NIDCM patients free from coronary artery disease and moderate or severe valvular heart disease were included in this single-center observational retrospective longitudinal study. Those with atrial fibrillation and a follow-up <12 months were excluded. Major adverse cardiovascular events (MACE) were defined as a composite of all-cause death, HF hospitalization, and ambulatory intravenous diuretics administration. LV HDFs were analyzed with a prototype software. Apex-base (HDFs-ab), lateral-septal (HDFs-ls), and HDFs-angle were computed. Results: Ninety-seven patients were included, sixty-seven (69%) were males, mean age was 62 ± 14 years, and mean LVEF was 39.2 ± 8.6%. During a median follow-up of 4.2 (3.1-5.1) years, 19 (20%) patients experienced MACE. These patients had a higher HDFs-angle (71.0 (67.0-75.0) vs. 68.0 (63.0-71.0)°, p = 0.005), lower HDFs-ls (1.36 (1.01-1.85) vs. 1.66 ([1.28-2.04])%, p = 0.015), but similar HDFs-ab (5.02 (4.39-6.34) vs. 5.66 (4.53-6.78)%, p = 0.375) compared to those without MACE. in a Cox regression analysis, HDFs-angle (HR 1.16 (95%-CI 1.04-1.30), p = 0.007) was associated with MACE, while other conventional echocardiography parameters, including LVEF and LV longitudinal strain, were not. Conclusions: HDFs-angle is associated with clinical endpoints in NIDCM. A higher HDFs-angle may be a marker of impaired myocardial performance in patients with reduced LVEF.
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Affiliation(s)
- Marco Cesareo
- Hypertension Unit, Division of Internal Medicine, University Hospital Città della Salute e della Scienza of Turin, Via Genova 3, 10126 Turin, Italy
- Department of Medical Sciences, University of Turin, Via Verdi 8, 10124 Turin, Italy
| | - Eduard Ródenas-Alesina
- Cardiology Department, Vall d'Hebron University Hospital, Passeig de la Vall d'Hebron 119-129, 08035 Barcelona, Spain
- Department of Medicine, Universitat Autonoma de Barcelona, Passeig de la Vall d'Hebron 119-129, 08035 Barcelona, Spain
- Centro de Investigación Biomédica en Red-Enfermedades Cardiovaculares (CIBERCV), Av. de Monforte de Lemos, 3-5, 28029 Madrid, Spain
| | - Andrea Guala
- Centro de Investigación Biomédica en Red-Enfermedades Cardiovaculares (CIBERCV), Av. de Monforte de Lemos, 3-5, 28029 Madrid, Spain
- Vall d'Hebrón Research Institute (VHIR), Pg. de la Vall d'Hebron, 119-129, 08035 Barcelona, Spain
| | - Jordi Lozano-Torres
- Cardiology Department, Vall d'Hebron University Hospital, Passeig de la Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Guillem Casas
- Cardiology Department, Vall d'Hebron University Hospital, Passeig de la Vall d'Hebron 119-129, 08035 Barcelona, Spain
- Centro de Investigación Biomédica en Red-Enfermedades Cardiovaculares (CIBERCV), Av. de Monforte de Lemos, 3-5, 28029 Madrid, Spain
| | - Fabrizio Vallelonga
- Department of Medical Sciences, University of Turin, Via Verdi 8, 10124 Turin, Italy
- Division of Internal Medicine, Candiolo Cancer Institute-Fondazione del Piemonte per l'Oncologia (FPO)-Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Strada Provinciale 142, KM 3.95, 10060 Turin, Italy
| | - Lorenzo Airale
- Hypertension Unit, Division of Internal Medicine, University Hospital Città della Salute e della Scienza of Turin, Via Genova 3, 10126 Turin, Italy
- Department of Medical Sciences, University of Turin, Via Verdi 8, 10124 Turin, Italy
| | - Ignacio Ferreira-González
- Cardiology Department, Vall d'Hebron University Hospital, Passeig de la Vall d'Hebron 119-129, 08035 Barcelona, Spain
- Department of Medicine, Universitat Autonoma de Barcelona, Passeig de la Vall d'Hebron 119-129, 08035 Barcelona, Spain
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Av. Monforte de Lemos, 3-5, 28029 Madrid, Spain
| | - Alberto Milan
- Department of Medical Sciences, University of Turin, Via Verdi 8, 10124 Turin, Italy
- Division of Internal Medicine, Candiolo Cancer Institute-Fondazione del Piemonte per l'Oncologia (FPO)-Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Strada Provinciale 142, KM 3.95, 10060 Turin, Italy
| | - Jose F Rodriguez-Palomares
- Cardiology Department, Vall d'Hebron University Hospital, Passeig de la Vall d'Hebron 119-129, 08035 Barcelona, Spain
- Department of Medicine, Universitat Autonoma de Barcelona, Passeig de la Vall d'Hebron 119-129, 08035 Barcelona, Spain
- Centro de Investigación Biomédica en Red-Enfermedades Cardiovaculares (CIBERCV), Av. de Monforte de Lemos, 3-5, 28029 Madrid, Spain
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Khayata M, Al-Kindi SG, Oliveira GH. Contemporary characteristics and outcomes of adults with familial dilated cardiomyopathy listed for heart transplantation. World J Cardiol 2019; 11:38-46. [PMID: 30705741 PMCID: PMC6354074 DOI: 10.4330/wjc.v11.i1.38] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 11/01/2018] [Accepted: 01/04/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Familial dilated cardiomyopathy (FDCM) account for 20%-30% of non-ischemic cardiomyopathies (NICM). Previous published data showed that some patients with FDCM tend to have rapidly progressive disease; however, five-year mortality was not significantly different in the familial and non-familial forms of NICM with optimal medical therapy.
AIM To better define the characteristics and clinical outcomes of FDCM patients listed for heart transplantation (HT).
METHODS We queried the United Network for Organ Sharing Registry to identify FDCM patients listed for HT between January 2008 and September 2015 and compared them to NICM and ischemic cardiomyopathy (ICM) patients. We included all patients ≥ 18 years old and we separated patients to three groups: FDCM, NICM and ICM. Chi-square test was used to compare between categorical variables, the t-test was used to compare between continues variables, and Cox-proportional hazards model was used to perform time-dependent survival analyses.
RESULTS Of the 24809 adults listed for HT, we identified 677 patients (2.7%) with the diagnosis of FDCM. Compared to patients with NICM and ICM, FDCM patients were younger (FDCM 43.9 ± 13.5 vs NICM 50.9 ± 12.3, P < 0.001, vs ICM 58.5 ± 8.1, P < 0.001), more frequently listed as status 2 (FDCM 35.2% vs NICM 26.5%, P < 0.001), with significantly lower left ventricular assist device (LVAD) utilization (FDCM 18.4% vs NICM 25.1%, P < 0.001; vs ICM 25.6%, P < 0.001), but higher use of total artificial heart (FDCM 1.3% vs NICM 0.6%, P = 0.039; vs ICM 0.4%, P = 0.002). Additionally, patients with FDCM were less frequently delisted for clinical deterioration or death and more likely to be transplanted compared to those with NICM [hazard ratio (HR): 0.617, 95% confidence interval (CI): 0.47-0.81; HR: 1.25, 95%CI: 1.14-1.37, respectively], and ICM (HR: 0.5, 95%CI: 0.38-0.66; HR: 1.18, 95%CI: 1.08-1.3, respectively). There was more frequent rejection among patients with FDCM (FDCM 11.4% vs NICM 9.8%, P = 0.28; vs ICM 8.4%, P = 0.034). One, three, and five post-transplant survival of patients with FDCM (91%, 88% and 80%) was similar to those with NICM (91%, 84%, 79%, P = 0.225), but superior to those with ICM (89%, 82%, 75%, P = 0.008), respectively.
CONCLUSION End-stage FDCM patients are more likely to be transplanted, more likely to have early rejection, and have similar or higher survival than patients with other cardiomyopathies.
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Affiliation(s)
- Mohamed Khayata
- Cardiology Section, Department of Internal Medicine, University Hospitals Cleveland Medical Center, Harrington Heart and Vascular Institute, Cleveland, OH 44106, United States
| | - Sadeer G Al-Kindi
- Cardiology Section, Department of Internal Medicine, University Hospitals Cleveland Medical Center, Harrington Heart and Vascular Institute, Cleveland, OH 44106, United States
| | - Guilherme H Oliveira
- Cardiology Section, Department of Internal Medicine, University Hospitals Cleveland Medical Center, Harrington Heart and Vascular Institute, Cleveland, OH 44106, United States
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Peric V, Jovanovic A, Sovtic S, Stolic R, Djikic D, Otasevic P. Temporal changes in plasma brain natriuretic peptide levels during exercise stress-echocardiography in patients with dilated cardiomyopathy. Int Heart J 2014; 55:428-32. [PMID: 25088584 DOI: 10.1536/ihj.14-028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The aim of this study was to evaluate temporal changes in brain natriuretic petide (BNP) levels during exercise stress-echocardiography in patients with dilated cardiomyopathy with respect to the left ventricular contractile reserve. We studied 55 consecutive patients with dilated cardiomyopathy (mean age, 55 ± 10 years, 49 (89.1%) male). All patients underwent exercise stress-echocardiography on a treadmill using the modified Bruce protocol. Contractile reserve was assessed by measuring changes in the wall motion score index (ΔWMSI) at rest and and at peak exercise. Levels of BNP were measured at rest, in the first minute, and after 20 minutes following termination of the stress test. Thirty-six patients had preserved left ventricular contractile reserve and 19 patients did not. Patients with preserved left ventricular contractile reserve showed a continuous rise in BNP levels from baseline to peak exercise and to 20 minutes following exertion (83.95 ± 108.51 versus 105.89 ± 116.00 versus 110.95 ± 119.70 ng/L, P < 0.001, respectively). On the other hand, patients without preserved left ventricular contractile reserve showed a decline in BNP levels at peak exercise as compared to baseline (335.49 ± 693.11 versus 320.08 ± 562.60 P = 0.031). ΔBNP was positively correlated with preserved contractile reserve (r = 0.46, P = 0.03) and lower NYHA class (r = -0.65, P = 0.001) in patients in whom baseline LVEF was lower than 20%. Multivariate analysis identified only WMSI at rest (beta -3.365, P = 0.008, 95 CI 0.03 to 0.411) as an independent predictor of left ventricular contractile reserve.The increase in BNP levels during exercise stress-echocardiography is associated with preserved left ventricular contractile reserve in patients with dilated cardiomyopathy.
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Affiliation(s)
- Vladan Peric
- University of Pristina, School of Medicine, Internal Clinic
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Moretti M, Merlo M, Barbati G, Di Lenarda A, Brun F, Pinamonti B, Gregori D, Mestroni L, Sinagra G. Prognostic impact of familial screening in dilated cardiomyopathy. Eur J Heart Fail 2014; 12:922-7. [DOI: 10.1093/eurjhf/hfq093] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Affiliation(s)
- Michele Moretti
- Cardiovascular Department; Azienda Ospedaliera ‘Ospedali Riuniti’ and University of Trieste; Trieste Italy
| | - Marco Merlo
- Cardiovascular Department; Azienda Ospedaliera ‘Ospedali Riuniti’ and University of Trieste; Trieste Italy
| | - Giulia Barbati
- Cardiovascular Department; Azienda Ospedaliera ‘Ospedali Riuniti’ and University of Trieste; Trieste Italy
| | - Andrea Di Lenarda
- Cardiovascular Center; Azienda per i Servizi Sanitari No. 1; Trieste Italy
| | - Francesca Brun
- Cardiovascular Department; Azienda Ospedaliera ‘Ospedali Riuniti’ and University of Trieste; Trieste Italy
| | - Bruno Pinamonti
- Cardiovascular Department; Azienda Ospedaliera ‘Ospedali Riuniti’ and University of Trieste; Trieste Italy
| | - Dario Gregori
- Department of Environmental Medicine and Public Health; University of Padova; Padova Italy
| | - Luisa Mestroni
- Cardiovascular Institute; University of Colorado; Denver CO USA
| | - Gianfranco Sinagra
- Cardiovascular Department; Azienda Ospedaliera ‘Ospedali Riuniti’ and University of Trieste; Trieste Italy
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Castelli G, Fornaro A, Ciaccheri M, Dolara A, Troiani V, Tomberli B, Olivotto I, Gensini GF. Improving Survival Rates of Patients With Idiopathic Dilated Cardiomyopathy in Tuscany Over 3 Decades. Circ Heart Fail 2013; 6:913-21. [DOI: 10.1161/circheartfailure.112.000120] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Gabriele Castelli
- From the Heart and Vessel Department, Referral Center for Cardiomyopathies, Careggi University Hospital, Florence, Italy
| | - Alessandra Fornaro
- From the Heart and Vessel Department, Referral Center for Cardiomyopathies, Careggi University Hospital, Florence, Italy
| | - Mauro Ciaccheri
- From the Heart and Vessel Department, Referral Center for Cardiomyopathies, Careggi University Hospital, Florence, Italy
| | - Alberto Dolara
- From the Heart and Vessel Department, Referral Center for Cardiomyopathies, Careggi University Hospital, Florence, Italy
| | - Vito Troiani
- From the Heart and Vessel Department, Referral Center for Cardiomyopathies, Careggi University Hospital, Florence, Italy
| | - Benedetta Tomberli
- From the Heart and Vessel Department, Referral Center for Cardiomyopathies, Careggi University Hospital, Florence, Italy
| | - Iacopo Olivotto
- From the Heart and Vessel Department, Referral Center for Cardiomyopathies, Careggi University Hospital, Florence, Italy
| | - Gian Franco Gensini
- From the Heart and Vessel Department, Referral Center for Cardiomyopathies, Careggi University Hospital, Florence, Italy
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Effect of left ventricular reverse remodeling on long-term prognosis after therapy with angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers and β blockers in patients with idiopathic dilated cardiomyopathy. Am J Cardiol 2011; 107:1065-70. [PMID: 21296328 DOI: 10.1016/j.amjcard.2010.11.033] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2010] [Revised: 11/12/2010] [Accepted: 11/12/2010] [Indexed: 10/18/2022]
Abstract
It remains unknown whether left ventricular (LV) reverse remodeling (LVRR) after therapy with angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers and β blockers is correlated with prognosis in patients with idiopathic dilated cardiomyopathy. Forty-two patients with idiopathic dilated cardiomyopathy treated with the therapy were studied. Complete left ventricular reverse remodeling was defined as LV end-diastolic dimension ≤ 55 mm and fractional shortening ≥ 25% at the last echocardiographic assessment. The incidence of complete LVRR was significantly higher in patients who survived than in those who died or underwent heart transplantation. Patients were divided into 3 groups: death or transplantation, alive with complete LVRR, and alive without complete LVRR. Although patients who died or underwent transplantation did not show any LV improvements, those with complete LVRR showed significant improvements at 1 to 6 months after starting the therapy. Patients without complete LVRR also showed small but significant improvements at 1 to 6 months. The decrease in LV end-systolic dimension from the initial value to that at 1 to 6 months was an independent determinant of future cardiac death or transplantation. In conclusion, complete LVRR is related to favorable prognosis in patients with idiopathic dilated cardiomyopathy. The extent of left ventricular reverse remodeling at 1 to 6 months after starting the therapy is predictive of long-term prognosis.
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Michels VV, Driscoll DJ, Miller FA, Olson TM, Atkinson EJ, Olswold CL, Schaid DJ. Progression of familial and non-familial dilated cardiomyopathy: long term follow up. Heart 2003; 89:757-61. [PMID: 12807850 PMCID: PMC1767723 DOI: 10.1136/heart.89.7.757] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND It is unknown whether progression of familial idiopathic dilated cardiomyopathy differs from progression in the non-familial form. It has been suggested that familial disease indicates a worse prognosis, and that this should be considered when planning the timing of heart transplantation. OBJECTIVE To compare five year survival or time to heart transplantation in an unselected series of patients with dilated cardiomyopathy who had been evaluated for familial v non-familial disease through the echocardiographic investigation of first degree relatives. DESIGN Medical records were reviewed and questionnaires were mailed to all patients who had previously participated in a family based study of dilated cardiomyopathy. Information was gathered about survival, heart transplantation, and left ventricular ejection fraction (LVEF) measurements. Survival data were censored at the time of cardiac transplantation. RESULTS Follow up data were obtained for 99 of 101 patients (69 with non-familial and 30 with familial disease). Five year survival was 55% for non-familial and 51% for familial patients (NS). The main predictor of mortality was an LVEF of < 30%. Familial status did not predict mortality. There was no significant difference in follow up LVEF values between the groups. CONCLUSIONS Five year survival is not significantly different in the familial and non-familial forms of dilated cardiomyopathy.
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Affiliation(s)
- V V Michels
- Department of Medical Genetics, Mayo Clinic/Foundation, Rochester, Minnesota 55905, USA.
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