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The variable natural history of idiopathic dilated cardiomyopathy.

Publication ,  Journal Article
Parakh, K; Kittleson, MM; Heidecker, B; Wittstein, IS; Judge, DP; Champion, HC; Barouch, LA; Baughman, KL; Russell, SD; Kasper, EK; Hare, JM ...
Published in: Isr Med Assoc J
November 2012

BACKGROUND: Determining the prognosis of patients with heart failure is essential for patient management and clinical trial conduct. The relative value of traditional prognostic criteria remains unclear and the assessment of long-term prognosis for individual patients is problematic. OBJECTIVES: To determine the ability of clinical, hemodynamic and echocardiographic parameters to predict the long-term prognosis of patients with idiopathic dilated cardiomyopathy. METHODS: We investigated the ability of clinical, hemodynamic and echocardiographic parameters to predict the long-term prognosis of individual patients in a large, representative, contemporary cohort of idiopathic dilated cardiomyopathy (IDCM) patients referred to Johns Hopkins from 1997 to 2004 for evaluation of cardiomyopathy. In all patients a baseline history was taken, and physical examination, laboratory studies, echocardiogram, right heart catheterization and endomyocardial biopsy were performed. RESULTS: In 171 IDCM patients followed for a median 3.5 years, there were 50 long-term event-free survivors (LTS) (median survival 6.4 years) and 34 patients died or underwent ventricular assist device placement or transplantation within 5 years (NLTS; non-long-term survivors) (median time to event 1.83 years. Established risk factors (gender, race, presence of diabetes, serum creatinine, sodium) and the use of accepted heart failure medications (angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, beta blockers) were similar between the two groups. Although LTS had younger age, higher ejection fraction (EF) and lower New York Heart Association (NYHA) class at presentation, the positive predictive value of an EF < 25% was 64% (95% CI 41%-79%) and that of NYHA class > 2 was 53% (95% CI 36-69%). A logistic model incorporating these three variables incorrectly classified 29% of patients. CONCLUSIONS: IDCM exhibits a highly variable natural history and standard clinical predictors have limited ability to classify IDCM patients into broad prognostic categories. These findings suggest that there are important host-environmental factors still unappreciated in the biology of IDCM.

Duke Scholars

Published In

Isr Med Assoc J

ISSN

1565-1088

Publication Date

November 2012

Volume

14

Issue

11

Start / End Page

666 / 671

Location

Israel

Related Subject Headings

  • Severity of Illness Index
  • Retrospective Studies
  • Prognosis
  • Myocardium
  • Middle Aged
  • Male
  • Humans
  • Hemodynamics
  • General & Internal Medicine
  • Follow-Up Studies
 

Citation

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Parakh, K., Kittleson, M. M., Heidecker, B., Wittstein, I. S., Judge, D. P., Champion, H. C., … Hare, J. M. (2012). The variable natural history of idiopathic dilated cardiomyopathy. Isr Med Assoc J, 14(11), 666–671.
Parakh, Kapil, Michelle M. Kittleson, Bettina Heidecker, Ilan S. Wittstein, Daniel P. Judge, Hunter C. Champion, Lili A. Barouch, et al. “The variable natural history of idiopathic dilated cardiomyopathy.Isr Med Assoc J 14, no. 11 (November 2012): 666–71.
Parakh K, Kittleson MM, Heidecker B, Wittstein IS, Judge DP, Champion HC, et al. The variable natural history of idiopathic dilated cardiomyopathy. Isr Med Assoc J. 2012 Nov;14(11):666–71.
Parakh, Kapil, et al. “The variable natural history of idiopathic dilated cardiomyopathy.Isr Med Assoc J, vol. 14, no. 11, Nov. 2012, pp. 666–71.
Parakh K, Kittleson MM, Heidecker B, Wittstein IS, Judge DP, Champion HC, Barouch LA, Baughman KL, Russell SD, Kasper EK, Sitammagari KK, Hare JM. The variable natural history of idiopathic dilated cardiomyopathy. Isr Med Assoc J. 2012 Nov;14(11):666–671.

Published In

Isr Med Assoc J

ISSN

1565-1088

Publication Date

November 2012

Volume

14

Issue

11

Start / End Page

666 / 671

Location

Israel

Related Subject Headings

  • Severity of Illness Index
  • Retrospective Studies
  • Prognosis
  • Myocardium
  • Middle Aged
  • Male
  • Humans
  • Hemodynamics
  • General & Internal Medicine
  • Follow-Up Studies