Etiology And Clinical Prognosis Of 60 Patients With Dilated Cardiomyopathy

Background and objective: Foreign studies have reported that different etiologies of Dilated cardiomyopathy(DCM)have different prognosis,and the prognosis of alcoholic cardiomyopathy is better than that of idiopathic Dilated cardiomyopathy.There are few relevant studies in China.The purpose of this study was to investigate the differences between alcoholic cardiomyopathy and idiopathic dilated cardiomyopathy in the outcome of hospitalization and long-term prognosis.Methods: 60 patients with dilated cardiomyopathy admitted to cardiovascular medicine department of our hospital from January 2016 to January 2018 were selected.The diagnostic criteria and exclusion criteria for dilated cardiomyopathy formulated by WHO/ISFC in 1995 and the recommendations for diagnosis and treatment of cardiomyopathy published in 2007 were used to select the study subjects.General data(gender,age,ethnicity,and alcohol consumption),previous medical history and family history of the patients were collected,and cardiac function classification(NYHA)was evaluated.Chest radiographs,echocardiography,NT-pro BNP,anti-ANT(Adenine nucleotide translocator)antibody and anti-β1AR(β1-adrenergic receptor)antibody were detected,as well as routine examinations.According to the diagnostic standard divided the patients into two groups,Alcoholic cardiomyopathy(Alcoholic cardiomyopathy,ACM)group(35 cases)and Idiopathic dilated cardiomyopathy(Idiopathic dilated cardiomyopathy,IDCM)(25 cases).During the hospitalization,ACM patients abstained from alcohol,and both groups were given oxygen therapy and drug treatment(Captopril,Carvedilol,Furosemide,Spironolactone,etc.).Heart rate,systolic blood pressure and cardiac function grading data of the patients were collected on the 3 days after treatment and on the day of discharge,and NT-pro BNP was reviewed 1day before discharge.All patients were followed up by outpatient or telephone visits at the 1st month,the 6th month,the 12 th month,the 18 th month,and the 24 th month,including medication and alcohol use,cardiac function,and the occurrence of end-point events(rehospitalization for heart failure and cardiovascular death).Kaplan-Meier curves were performed for the endpoint events in the two groups to analyze the prognosis of different etiologies.Cox regression was performed for the occurrence of endpoint events in 60 patients to analyze the prognostic factors.Results:1.The correlation analysis of the two factors showed that LVEF and NT-pro BNP were closely related to the classification of cardiac function.Correlation analysis of data of 60 patients in ACM group and IDCM group when enrolled showed that LVEF was negatively correlated with cardiac function classification(r:-0.481,P<0.01),indicating that the lower the LVEF,the worse the cardiac function classification.There was a positive correlation between NT-pro BNP and cardiac function classification(r:0.609,P<0.01),suggesting that the higher NT-pro BNP was,the worse the cardiac function classification was,and the difference of NT-pro BNP was observed among different cardiac function classification(P<0.05).2.The standardized anti-heart failure treatment in ACM group was more effective than that in IDCM group.During the period of hospitalization after enrollment,ACM patients abstained from alcohol,and there was no statistical difference in medication between the two groups(P>0.05).The average daily NT-pro BNP changes in the ACM group during hospitalization were significantly greater than that in the IDCM group [(-397.14±216.82)pg/ml vs(-239.87±161.63)pg/ml,P<0.05].The length of stay in ACM group was lower than that in IDCM group(10.11±2.42 days vs 12.16±3.48 days,P<0.05).3.The ACM group were followed up for 1 year cardiac function classification compared with cardiac function classification on admission,cardiac function classification improved(P < 0.05),the IDCM group were followed up for 1 year cardiac function classification compared with cardiac function classification on admission,no statistical difference(P >0.05),ACM group compared with IDCM group were followed up for 1 year cardiac function classification,no statistical difference(P > 0.05).4.At the end of the follow-up,the incidence of endpoint events in the ACM group was lower than that in the IDCM group.There were 10 end-point events in the ACM group(2 died of heart failure and 8 were hospitalized for heart failure)and 14 cases in the IDCM group(1sudden cardiac death,3 died of heart failure and 10 were hospitalized for heart failure).The Kaplan-Meier curve showed that there was a significant difference in K-M curves between the ACM group and the IDCM group(log-rank test,P<0.05).5.Cox regression analysis showed that the classification of cardiac function(OR=2.056,P=0.038)and the grouping of etiology(OR=0.258;P=0.007)were independent predictors of prognosis.That is,cardiac function classification is the main independent predictor of the prognosis of dilated cardiomyopathy,and different etiology is also one of the independent predictors of the prognosis.Conclusion:1.The efficacy of standardized anti-heart failure treatment in ACM group during hospitalization was better than that in IDCM group.2.The ACM group were followed up for1 year cardiac function classification compared with cardiac function classification on admission,cardiac function classification improved.3.After 2 years of follow-up,the incidence of cardiovascular death and re-hospitalization for heart failure in the ACM group was lower than that in the IDCM group.4.The lower the LVEF and the higher the NT-pro BNP,the worse the classification of cardiac function.5.Cardiac function classification was the main independent predictor of the prognosis of dilated cardiomyopathy at the time of enrollment,and different etiology was also one of the independent predictors of the prognosis.