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Dilated cardiomyopathy with midrange ejection fraction at diagnosis: characterization and natural history

Session Comorbidities and cardiomyopathies - How to manage?

Speaker Antonio Cannata

Event : Heart Failure 2018

  • Topic : valvular, myocardial, pericardial, pulmonary, congenital heart disease
  • Sub-topic : Dilative Cardiomyopathy
  • Session type : Rapid Fire Abstracts

Authors : P Gentile (Trieste,IT), M Merlo (Trieste,IT), A Cannata' (Trieste,IT), M Gobbo (Trieste,IT), M Mase (Trieste,IT), D Zaffalon (Trieste,IT), M Gigli (Trieste,IT), G Barbati (Trieste,IT), F Ramani (Trieste,IT), D Stolfo (Trieste,IT), B Pinamonti (Trieste,IT), G Sinagra (Trieste,IT)

P Gentile1 , M Merlo1 , A Cannata'1 , M Gobbo1 , M Mase1 , D Zaffalon1 , M Gigli1 , G Barbati2 , F Ramani1 , D Stolfo1 , B Pinamonti1 , G Sinagra1 , 1Ospedale Cattinara, Cardiovascular Department - Trieste - Italy , 2University of Trieste, Biostatistics Unit, Department of Medical Sciences - Trieste - Italy ,


Background. Few data on the characteristics and outcomes of mid-range EF (mrEF) patients are available, mostly in the specific group of dilated cardiomyopathy (DCM).

Purpose. To define characteristics, evolution and prognosis of DCM patients with mrEF at diagnosis.

Methods DCM patients were analyzed. mrEF and reduced EF (rEF) were defined in presence of baseline left ventricular EF between 40 and 49% and <40% respectively. The study end-points were all-cause mortality or heart transplantation (D/HT) and sudden cardiac death or malignant ventricular arrhythmias (SD/MVA). EF worsening below 40% during follow-up was also considered.

Results. Among 812 DCM enrolled patients, 175 (22%) presented mid-range EF at baseline. Compared with rEF group, mrEF patients had smaller left ventricular end-diastolic volume, lower rates of left bundle branch block, right ventricular dysfunction, moderate–severe mitral regurgitation and restrictive filling pattern. During a mean follow–up of 135±87 months, mrEF group presented a lower rate of D/HT (9.1% vs. 36%, p‹0.001) and SD/MVA (4.5% vs.15.2%, p‹0.001). Finally, 29 out of 175 mrEF patients (17%) evolved to rEF at a mean follow–up of 64±40 months, showing a subsequent worsening of long–term prognosis. A restrictive filling pattern emerged as the strongest predictor of rEF development at multivariate analysis. Conclusions.  mrEF identified a consistent subgroup of DCMs diagnosed in an earlier stage and presenting an apparent better long-term evolution. However, 17% of those patients evolved into rEF despite medical therapy. Baseline restrictive filling pattern was found to be independently associated with subsequent evolution in rEF.

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