Dilated Cardiomyopathy:clinical Features And Analyses Of Predicted Factors Of Long Term Outcoms

Background: Dilated cardiomyopathy(DCM) is the most common form of cardiomyopathy in clinical practice, which can worse progressively and lead to death at any stage. DCM is a main cause of heart failure and heart transplantation, and its prognosis is relatively poor. The present study was designed to explore the clinical features and prognosis in a cohort of C hinese patients with DCM from Beijing Anzhen Hospital and to identify some long prognosis factors.Methods: We retrospectively studied DCM patients with heart failure(HF) admitted in our hospital from January 2010 to Octobe r 2014.All patients were followed–up until either October 2015 or death/heart transplantation after discharge. Recovered LVEF was defined as > 50% during follow-up. The endpoints were all-cause deaths or heart transplantation. One-year and 5- year mortality rate were calculate drespectively,as well as the predictors of clinical outcome analyzed.Results: A total of 300 eligible patients were enrolled in this research. Among all the patients, 223 patients(74.3%)were male, and they were first diagnosed by the age of 46.6±14.9. Percentages of patients at the stage of NYHA class I-II III and IV were 23.1%, 51.3% and 25.3%, respectively. Sixty-seven(22.2%)patients were with atrial fibrillation, 59(19.7%)with left bundle branch block, According to echocardiography, 171(57.0%) patients showed left cardiac chambers enlargement, 97 patients showed all four chambers enlargement. Percentages of patients receiving angiotensin-converting enzyme inhibitors/angiotensin receptors blockers, β-blockers is 87.7%,92.1%, respectively. After a median follow-up period of 27 months, 276 patients have follow-up UCG report,,82 patients(29.7%) had a recovery of LVEF who showed a significant increase in LVEF from 33.7%±7.1% to57.6%±6.2%(p < 0.001), Multivariable logistic regression analysis presented that shorter heart failure history(>6 months vs ≤ 6 months,OR=0.420,P<0.01)、shorter QRS duration(OR=0.925,95% CI:0.895~0.976,P<0.01),higher systolic blood pressure(per 10 mm Hg elevation, OR=1.217, P<0.01), smaller left ventricular end-diastolic diameter(LVEDD)(O R=0.892, P<0.01) and higher LVEF(OR=1.135, P<0.05),using AC EI(OR=2.438, P<0.05)were the independent predictors for LVEF recovery. During follow-up, 43 patients(14.3%) reached an end point including death(heart failurerelated, n=23; sudden death, n=6; and noncardiac, n=17) or cardiac transplant(n=10), 22 patients received ICD/CRTD treatment. Cox’s proportional hazards regression model presents that N YHA class(OR=1.523,P=0.042)、HR(OR=1.489,P=0.002)、SBP(OR=0.926,P<0.001)、Q RS duration(O R=1.011,P=0.001)、 LVEDD(OR=1.216,P<0.001)、LVEF(OR=0.919,P=0.001)、c Tn I(OR=2.573,P<0.047)、Cr(OR=1.054,P<0.001)、β-recepotor blocker(OR=0.893,P<0.001)\Na(OR=1.172,P<0.001)are independent prognostic factors. The transplant free survial rates at 1 and 5 years after diagnosis were 94.8% and 65.4%, respectively.Conclusion: Middle-aged men acounted for the majority of DCM in this cohort. Most patients manifested heart failure of NYHA class III-IV with complex arrhythmias and enlargement of cardiac chambers when diagnosed.With standard medication, a portion of DCM patients with HF could have their LVEF recovered to normal level, which related to heart failure history, QRS duration, systolic blood pressure, LVEDD, LVEF. Also, NYHA class, Systolic blood pressure, QRS duration, LVEDD, LVEF, c Tn I, serum creatinine, β-recepotor blocker, and natrium are independent prognostic factors of DCM. The transplant free survial rates at 1 and 5 year have already improved. Heart failure and sudden death were still the main causes of mortality.