The Prognosis Of Ischemic Cardiomyopathy With Left Ventricular Dysfunction

Objective This retrospective cohort study is designed to analyse the effects of cardiovascular risk factors, echocardiographic parameters, and other parameters in the prognosis of ischemic cardiomyopathy during long term following-up in patients admitted in our hospital. The left ventricular eject fraction of all patients were less than thirty percent which were confirmed by coronary arteriography. All of the patients were not receive the treatment of implantable cardioverter defibrillator or cardiac resynchronization therapy. We hope to find the effects factors related with survival rate through long term following-up.Methods The consequentive in-patients with definite diagnosis of ischemic cardiomyopathy from Jan 2002 to Jun 2012. The data of demography, cardiovascular risk factors, blood biochemistry, echocardiographic measurements (in hospital), and the pharmacological treatment were collected. The following-up methods used in this study included:clinic consultation, telephone consultation and locating identity card. The items of following-up include recurrence of end-poings. The primary end-point means all cause deaths, the secondary end point include all cause death, sudden cardiac death, readmission of heart failure, ventricular tachycardia and/or ventricular fibrillation events, heart transplantation.Result We studied 1599 patients,9 patients were lost and the rate of following-up is 99.4%. The age of 1590 patients is 58.9+9.8±(28～87) years old,80.3% of the study patients were men. This study included 69.8% patients with hypertension and 27.2% patients with diabetes. The follow-up time is 31±9.3 months, the median follow-up time is 19 months. During the end of follow-up period,106 patients (6.7%) reached study primary end-points, including 95 patients death from heart disease,29 patients death from sudden cardiac death.156 patients (9.8%) reached the secondary end-points. The survival rates of 1 year,2 year, and above 2 years were 99%,95%, and 94%, respectively.Conclusion1. The occurrence of all cause death, readmission of heart failure, heart transplantation, and ventricular tachycardia and/or ventricular fibrillation was increased with age. The rate of all cause death was highest in the 61-70 age group.2. Men patients were significantly higher than women patients in both of the primary end-point of all cause death and the secondary end-poin including all caused death, ventricular tachycardia and/or ventricular fibrillation, readmission from heart failure, and heart transplantation.3. Cox regression was performed to investigate the relationship between ischemic cardiomyopathy risk factors and the occurrence of end-points during follow-up. After adjustment of related factors, the risk factors of end-points included:anterior myocardial infarction, left ventricular eject fraction is less than 30% in echocardiography, the formation of ventricular aneurysm, the width of QRS≥120ms, and with left bundle branch block.4. Survival analysis showed that in the patients with left ventricular eject fraction less than 30% which confirmed by coronary angiograrm. For those patients with anterior myocardial infraction, completed left bundle branch block, the width of QRS more than 150ms, the occurrence of all cause death, readmission from heart failure, ventricular tachycardia and/or ventricular fibrillation, heart transplantation increased obviously. It is urgent to make good use of other prevention and treatment system to improve the prognosis of these patients future.Objective The effects of ventricular arrhythmia occurrence on ischemic cardiomyopathy patients in survival analysis of long term follow-up.Methods The patients criteria included left ventricular eject fraction less than 35% confirmed by coronary angiogram and undergoing Holter recording for inspecting of ventricular arrhythmia occurrence. The patients were divided into ventricular arrhythmia group and no ventricular arrhythmia group. The data of demography, cardiovascular risk factors, blood biochemistry, echocardiographic measurements (in hospital), and the pharmacological treatment were collected. The following-up methods used in this study included:clinic consultation, telephone consultation and locating identity card. The items of following-up include recurrence of end-poings. The primary end-point means all cause deaths, the secondary end point include all cause death, sudden cardiac death, readmission of heart failure, ventricular tachycardia and/or ventricular fibrillation events, heart transplantation. We compare the different characteristics between two groups and hope to identify the risk factors of primary and secondary end-point events.Result Total 209 patients were recruited, male was dominant (86%), mean age was 59±8.4 years.155(74%) patients had the history of hypertension.53(25%) patients had the history of diabetes.131(63%) patients had the history of anterior myocardial infraction.25(12%) patients had the history of complete bundle branch.184(89%) patients had narrow QRS width±120ms) through ECG. 19(9%) patients were proved QRS width between 120ms and 150ms through ECG. 6(3%) patients were proved QRS width>150ms through ECG.167(80%) patients were diagnosed the heart failure and received the regular treatment first time when they were in our hospital.During the follow-up time,22 patients (10.5%) reached study primary end-points, including 17 patients death from heart disease,13 patients death from sudden cardiac death.47 patients (23%) reached the secondary end-points. The survival rates of 1 year,2 year, and above 2 years were 99%,96%, and 89%, respectively. The occurrence of secondary end-point events in ventricular arrhythmia group was higher than no ventricular arrhythmia group. The sudden death was account for most cause of death, the rate in ventricular arrhythmia group and no ventricular arrhythmia group is 60% and 58%, respectively. Cox regression showed that the risk factors of secondary end-point included:anterior myocardial infarction, left ventricular eject fraction is less than 30% in echocardiography, the formation of ventricular aneurysm, the width of QRS>150ms, and existing of ventricular arrhythmia.Conclusion1. During follow-up times, the survival rate rate of 1 year,2 years, and above 2 year on ischemic cardiomyopathy patients with left ventricular eject fraction less than 35% confirmed by coronary angiogram was 99%,96%, and 89%, respectively. The sudden death was the main reason of all cause of death.2. The patients of ventricular arrhythmia group were more likely to reach the secondary end-point than no ventricular arrhythmia group.3. The risk factor of all cause death included male, complete left bundle branch block, anterior myocardial infraction, and ventricular arrhythmia occurrence. The use of β-blocker was the protective factor of all cause death. The risk factors of all cause death, readmission from heart failure, ventricular tachycardia and/or ventricular fibrillator occurrence, heart transplantation were anterior myocardial infarction, left ventricular eject fraction is less than 35% in echocardiography, the formation of ventricular aneurysm, the width of QRS>150ms.