Long-term Clinical Outcomes and Prognostic Factors in Idiopathic Dilated Cardiomyopathy

Hong, Young Joon; Park, Jong Chun; Rhew, Jay Young; Lee, Seung Hyun; Park, Ok Young; Jung, Woo Kon; Lee, Sang Rok; Yum, Joo Hyub; Kim, Joo Han; Kim, Woen; Ahn, Young Kun; Jeong, Myung Ho; Cho, Jeong Gwan; Kang, Jung Chaee

Abstract

The prognostic factors in patients with idiopathic dilated cardiomyopathy (IDCM) have not been known exactly in Korea. The aim of this study was to determine the role of clinical and echocardiographic parameters on survival in patients with IDCM. We retrospectively evaluated the long-term clinical outcomes and predictors of survival in 97 patients, in which patients the ejection fraction was less than 50% and the left ventricular end-diastolic dimension (LVEDD) was more than 55mm, and followed for three years, referred from 1990 to 1997 for evaluation of IDCM. The patients were divided into two groups (Group I: NYHA class I-II, n=64, 55.5 13.6 years, 59.4% male, Group II: NYHA class III-IV, n=33, 61.5 14.2 years, 48.5% male). The mean age was higher in group II (55.5 13.6 years vs 61.5 14.2 years, p=0.046), and S3 and rales were more frequently observed in group II (12.5% vs 42.4%, p=0.001). There were significant differences in LVEDD (63.9 10.4mm vs 70.3 5.0mm, p<0.001), left ventricular end-systolic dimension (LVESD) (52.9 11.0mm vs 60.0 6.2mm, p<0.001), ejection fraction (37.1 13.0% vs 26.4 5.7%, p<0.001), E/A ratio (1.19 0.41 vs 1.83 0.27, p<0.001), Ejection time (296.1 31.9msec vs 248.8 28.0msec, p<0.001), TEI index (0.64 0.15 vs 1.03 0.17, p<0.001) between two groups at the time of first evaluation. The survival rate of group I was 93.8%, 87.5% and 82.8% and that of group II was 87.9%, 72.7% and 63.6% at 1 year, 2 and 3 year follow-up (p=0.319, 0.070, 0.035, respectively). Multiple logistic regression analysis of these variables showed that the TEI index (p<0.001) and NYHA class (p=0.022) were the most significant independent predictors of outcome, and the TEI index reflected disease severity and had incremental prognostic value in patients with IDCM.