Zhonghua xin xue guan bing za zhi · 2015
[Recovery and relapse of left ventricular systolic dysfunction in hospitalized patients with dilated cardiomyopathy: frequency and related factors].
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Zhang Jian, Zou Changhong, Huang Yan, Zhou Qiong, Zhang Yuhui, Lyu Rong
Аннотация
OBJECTIVE: To investigate the frequency and predictors of recovery and relapse of left ventricular systolic dysfunction (LVSD) in hospitalized patients with dilated cardiomyopathy (DCM).
METHODS: Patients with DCM hospitalized in Fuwai Hospital from October 2008 to December 2013 with repeat echocardiography results after discharge were reviewed and followed to December 2014 or until all-cause death or cardiac transplantation. Rate of recovery of LVSD, defined as an absolute increase in left ventricular ejection fraction (LVEF) of >10% to a level of >50% on follow-up, and those with relapse of LVSD, defined as a decrease in LVEF to a level of <45% after initial recovery was obtained and related factors affecting LVSD recovery and relapse were analyzed.
RESULTS: After a mean follow-up of (28 ± 17) months, recovery of LVSD was evidenced in 114 of 382 patients (29.8%), LVEF increased from (31.6 ± 6.0) % to (55.8 ± 3.7) % (P<0.01) and left ventricular end-diastolic diameter (LVEDD) decreased from (65.1 ± 6.7) mm to (53.5 ± 4.9) mm (P<0.01) in these patients. Multiple logistic regression analysis showed that symptom duration of heart failure (OR=0.986, P<0.01), systolic blood pressure (SBP) (OR=1.026, P<0.01), LVEDD (OR=0.938, P<0.01) and LVEF (OR=1.038, P<0.05) at admission were independent predictors of LVSD recovery. During the subsequent follow-up of (24 ±1 3) months after initial recovery, 17 of 88 patients (19.3%) suffered a relapse of LVSD, LVEF decreased from (54.3 ± 2.6) % to (36.6 ± 5.1) % (P<0.01), LVEDD increased from (57.5 ± 4 .2) mm to (62.8 ± 6.8) mm (P<0.01) in these patients. Multiple logistic regression analysis showed that less decrease in LVEDD at initial recovery of LVSD was independent predictor of LVSD relapse.
CONCLUSIONS: About 30% hospitalized patients with DCM experienced LVSD recovery in this patient cohort. Symptom duration of heart failure, SBP, LVEDD and LVEF on admission were predictors of LVSD recovery. Moreover, LVSD relapse was observed in around 20% patients after initial LVSD recovery and less decrease in LVEDD at initial recovery serves as an independent risk factor for LVSD relapse.
METHODS: Patients with DCM hospitalized in Fuwai Hospital from October 2008 to December 2013 with repeat echocardiography results after discharge were reviewed and followed to December 2014 or until all-cause death or cardiac transplantation. Rate of recovery of LVSD, defined as an absolute increase in left ventricular ejection fraction (LVEF) of >10% to a level of >50% on follow-up, and those with relapse of LVSD, defined as a decrease in LVEF to a level of <45% after initial recovery was obtained and related factors affecting LVSD recovery and relapse were analyzed.
RESULTS: After a mean follow-up of (28 ± 17) months, recovery of LVSD was evidenced in 114 of 382 patients (29.8%), LVEF increased from (31.6 ± 6.0) % to (55.8 ± 3.7) % (P<0.01) and left ventricular end-diastolic diameter (LVEDD) decreased from (65.1 ± 6.7) mm to (53.5 ± 4.9) mm (P<0.01) in these patients. Multiple logistic regression analysis showed that symptom duration of heart failure (OR=0.986, P<0.01), systolic blood pressure (SBP) (OR=1.026, P<0.01), LVEDD (OR=0.938, P<0.01) and LVEF (OR=1.038, P<0.05) at admission were independent predictors of LVSD recovery. During the subsequent follow-up of (24 ±1 3) months after initial recovery, 17 of 88 patients (19.3%) suffered a relapse of LVSD, LVEF decreased from (54.3 ± 2.6) % to (36.6 ± 5.1) % (P<0.01), LVEDD increased from (57.5 ± 4 .2) mm to (62.8 ± 6.8) mm (P<0.01) in these patients. Multiple logistic regression analysis showed that less decrease in LVEDD at initial recovery of LVSD was independent predictor of LVSD relapse.
CONCLUSIONS: About 30% hospitalized patients with DCM experienced LVSD recovery in this patient cohort. Symptom duration of heart failure, SBP, LVEDD and LVEF on admission were predictors of LVSD recovery. Moreover, LVSD relapse was observed in around 20% patients after initial LVSD recovery and less decrease in LVEDD at initial recovery serves as an independent risk factor for LVSD relapse.