Cardiomyopathy etiologies and survival analysis in a cohort of patients with chronic heart failure

    Authors

    Keywords

    cardiomyopathy, heart failure, NT-proBNP, mortality

    DOI

    https://doi.org/10.15836/ccar2017.355

    Full Text

    Introduction : Accounting for the largest number of hospitalizations, heart failure (HF) currently creates a large burden on the health systems in Europe. Myocardial diseases, one of the most frequent causes of HF, are predominantly represented by ischemic cardiomyopathy (ICM), while hypertrophic cardiomyopathy (HCM) is often recognized as the second most frequent form of cardiomyopathy. ( 1 ) The aim of this study was to describe the etiological characteristics and survival within our HF cohort. Patients and Methods : We performed a retrospective analysis of data from 200 patients (71% male, mean age 47.8±11.7 years) with mild to moderate chronic HF (NYHA II and IIIa) treated at our Department between December 2010 and December 2014. The mean follow-up period was 44.9±16.5 months and overall survival was defined as the primary outcome of the study. Results : The most frequent etiologies of HF included dilated cardiomyopathy (DCM) (25%), ICM (26.5%) and secondary cardiomyopathy (hypertensive, valvular, toxic) (19.5%), while HCM accounted for only 8% of the cohort ( Figure 1 ). The overall survival in our cohort was 92%. No significant difference in the demographic parameters was noted among the surviving and deceased patients, except higher age and prevalence of diabetes in the deceased group. The majority of deceased patients were of DCM (8/15 deceased) and ICM (6/15) etiology. A trend towards higher overall mortality was noted in the DCM group compared to ICM, yet not reaching statistical significance (p=0.116) ( Figure 2 ), while multivariate analysis revealed this to be due to significantly lower EF in the DCM group. There was no significant difference in the demographic parameters, except age, among the surviving and deceased patients. By log rank test and ROC analysis, NT-proBNP provided the strongest prediction of mortality in the entire HF cohort (area under the curve 0.702, p<0.05) ( Figure 3 ). Distribution of cardiomyopathy etiologies.
DCM = dilated cardiomyopathy, ICM = ischemic cardiomyopathy, Secondary CM = secondary cardiomyopathy, HCM = hypertrophic cardiomyopathy, RCM = restrictive cardiomyopathy, ARC = arrhythmogenic right ventricular cardiomyopathy, Myocarditis = cardiomyopathy after myocarditis, LVNC = left ventricular non-compaction cardiomyopathy Kaplan-Meier survival curves for the subgroups of patients with dilated and ischemic cardiomyopathy. Kaplan-Meier survival curves according to NTproBNP levels. Conclusion : Interestingly, the prevalence of DCM in our cohort is much higher than that described in European registries. NT-proBNP was confirmed to be a very reliable predictor of mortality in a diverse HF cohort. Our study suggests higher mortality in DCM patients (despite a younger age) compared to ICM, but a larger patient cohort and longer follow-up time is needed to confirm this trend.

    Cardiologia Croatica
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    Cardiomyopathy etiologies and survival analysis in a cohort of patients with chronic heart failure

    Extended Abstract
    Issue9-10
    Published
    Pages355-356
    PDF via DOIhttps://doi.org/10.15836/ccar2017.355
    cardiomyopathy
    heart failure
    NT-proBNP
    mortality

    Authors

    Gloria Lekšić*ORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Jasmina HranjecORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Marijan PašalićORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Boško SkorićORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Jure SamardžićORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Jana LjubasUniversity Hospital Centre Zagreb, Zagreb, Croatia
    MačekORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Daniel LovrićORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Hrvoje JurinORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Ivo PlanincORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Dora FabijanovićUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Nina JakušORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Davor MiličićORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Maja ČikešORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia

    Full Text

    Introduction : Accounting for the largest number of hospitalizations, heart failure (HF) currently creates a large burden on the health systems in Europe. Myocardial diseases, one of the most frequent causes of HF, are predominantly represented by ischemic cardiomyopathy (ICM), while hypertrophic cardiomyopathy (HCM) is often recognized as the second most frequent form of cardiomyopathy. ( 1 ) The aim of this study was to describe the etiological characteristics and survival within our HF cohort. Patients and Methods : We performed a retrospective analysis of data from 200 patients (71% male, mean age 47.8±11.7 years) with mild to moderate chronic HF (NYHA II and IIIa) treated at our Department between December 2010 and December 2014. The mean follow-up period was 44.9±16.5 months and overall survival was defined as the primary outcome of the study. Results : The most frequent etiologies of HF included dilated cardiomyopathy (DCM) (25%), ICM (26.5%) and secondary cardiomyopathy (hypertensive, valvular, toxic) (19.5%), while HCM accounted for only 8% of the cohort ( Figure 1 ). The overall survival in our cohort was 92%. No significant difference in the demographic parameters was noted among the surviving and deceased patients, except higher age and prevalence of diabetes in the deceased group. The majority of deceased patients were of DCM (8/15 deceased) and ICM (6/15) etiology. A trend towards higher overall mortality was noted in the DCM group compared to ICM, yet not reaching statistical significance (p=0.116) ( Figure 2 ), while multivariate analysis revealed this to be due to significantly lower EF in the DCM group. There was no significant difference in the demographic parameters, except age, among the surviving and deceased patients. By log rank test and ROC analysis, NT-proBNP provided the strongest prediction of mortality in the entire HF cohort (area under the curve 0.702, p<0.05) ( Figure 3 ). Distribution of cardiomyopathy etiologies.
DCM = dilated cardiomyopathy, ICM = ischemic cardiomyopathy, Secondary CM = secondary cardiomyopathy, HCM = hypertrophic cardiomyopathy, RCM = restrictive cardiomyopathy, ARC = arrhythmogenic right ventricular cardiomyopathy, Myocarditis = cardiomyopathy after myocarditis, LVNC = left ventricular non-compaction cardiomyopathy Kaplan-Meier survival curves for the subgroups of patients with dilated and ischemic cardiomyopathy. Kaplan-Meier survival curves according to NTproBNP levels. Conclusion : Interestingly, the prevalence of DCM in our cohort is much higher than that described in European registries. NT-proBNP was confirmed to be a very reliable predictor of mortality in a diverse HF cohort. Our study suggests higher mortality in DCM patients (despite a younger age) compared to ICM, but a larger patient cohort and longer follow-up time is needed to confirm this trend.