Clinical Features, Treatment And In-hospital Mortality In Patients Hospitalized For Ischemic Cardiomyopathy Or Idiopathic Dilated Cardiomyopathy

Background:Both Ishemic cardiomyopathy (ICM) and Idiopathic dilated cardiomyopathy (IDCM) are major etiology of heart failure (HF). ICM and IDCM have different clinical features and management. Previous studies had associatedHF of ischemic etiology with worse prognosis compared to HF from non-ischemic. With ageing populations as well as improvements in treatment in recent years, has there been an imapct on this prognostic gap?Objective:The aim of our study was to find the differences of clinical features,treatment and outcome (including in-hospital mortality and duration of hospital stay) between patients with ICM and patients with IDCM. And then we wanted to find some predictors of in-hospital mortality in patients with ICM orIDCM.Methods:We reviewed the medical records of patients with a discharge diagnosis of ICM or IDCM at the Department of Cardiology, Qilu Hospital of Shandong University (Shandong, China) during January1,2000and May31,2011. And we compared clinical characteristics, medical history, comorbidities, laboratory data (at admission), echocardiographic, admission medications, and outcome in patients with ICM with that in patients with IDCM. To analysis the differences between ICM and IDCM, we compared NYHA Ⅱ/Ⅲ group with NYHA IV group in above factors. Then a logistic regression model was constructed to identify significant predictors of in-hospital mortality.Results:Of676patients included (ICM=454, IDCM=222), ICM group was older than IDCM group (68.65±10.155vs.48.77±14.304, p<0.001), and lowerproportion of man (68.1%vs.79.3%, p=0.002). ICM group had also lower proportion of following comorbidities:hypertension, diabetes, cerebrovascular accident, artial fibrillation, and chronic obstructive pulmonary disease or chronic bronchitis. Moreover, ICM group had higher frequency of being given statins, aspirin, and antibiotics, while the frequency of use of diuretics or digitalis was lower. And there were no significant difference in usage of β-blocker or AECI/ARB.20patients died during admission. The mortality was3%. The mortalityof ICM group and IDCM group was similar (p=0.24). The mean duration of hospital stay of all patients was16.94±9.722day. And ICM group seemed to have similar length of duration of hospital stay with IDCM group. Etiology ofHF was not associated with in-hospital mortality (p=0.245). Multivariable predictors of in-hospital mortality included serum creatinine and alanineaminotransferase (ALT), while use of antibiotics was of borderline significance (p=0.059).Conclusions:ICM patients has more risk factors of coronary atherosclerotic heart disease (CAD) than IDCM patients. The risk factors are more strictly contralled in CAD patients. The in-hospital mortality of patients with ICM seems to be similar with patients with IDCM. Serum creatinine and ALT at admission are the predictors of in-hospital mortality.