| Purpose:Dilated cardiomyopathy(DCM)is one of the common diseases that cause heart failure(HF),arrhythmia and cardiac death.It is often difficult to determine the severity,stage and prognosis of acute HF in DCM.During the course of DCM(from subclinical asymptomatic stage to acute progression of HF),persistent increased pulmonary arterial pressure or decreased systemic arterial pressure may affect the main pulmonary artery diameter(PAD),the ascending aortic diameter(AoD)and the ratio of them(PAD/AoD).In this study,the values of PAD,AoD and PAD/AOD in patients with acute HF of DCM were obtained by CT scan,and the relationship between these parameters and the severity and prognosis of acute HF was evaluated.Methods:1.From January 2018 to January 2019,the patients(?65 years old)who were admitted to the Department of Cardiology in North of Jiangsu People's hospital because of DCM with acute HF(NYHA ?/?)were selected as the case group(N=120),and the healthy subjects whose age,sex and body surface area were matched were selected as the control group(N=50).All selected patients underwent blood routine,biochemical,echocardiographic and chest CT examinations,excluding lung diseases,severe valvular diseases,acute and chronic infectious diseases,severe liver and renal dysfunction,malignant tumors,hematological and endocrine system diseases such as hypothyroidism or hyperthyroidism,etc,and those with history of angina pectoris and myocardial infarction were excluded,too.2.Collected the medical history and the general baseline data of the patients in the group were recorded,such as age,sex,height,weight,blood pressure,HF history,hypertension history,diabetes mellitus history,smoking history,etc.And laboratory and imaging examinations after admission:aspartate aminotransferase,total bilirubin,creatinine,hemoglobin,low density lipoprotein,brain natriuretic peptide(BNP),left ventricular ejection fraction(LVEF),left ventricular diameter,left atrial diameter,mitral and tricuspid regurgitation,tricuspid pressure difference,PAD,AoD,PAD/AoD,etc3.According to PAD/AOD,patients with DCM were divided into high PAD/AoD group(median?1.05)and low PAD/AoD group(median<1.05).After one year of follow-up,major adverse cardiac events(MACE)occurred in each group were counted as the main end point,including cardiac death and HF readmission.Results:1.Comparison of clinical parameters between healthy control group and DCM group:Compared with controls,DCM patients had smaller AoD(28.44±3.80mm vs 31.74 ± 2.27mm)and measured AoD/predicted AoD(0.85±0.10 vs 0.96±0.06),larger PAD(29.24±3.35mm vs 25.78±2.38mm)and PAD/AoD(1.04±0.11 vs 0.81±0.06;all P<0.01)2.Comparison of clinical characteristics between high PAD/AoD group(median>1.05)and low PAD/AoD group(median<1.05)in DCM group:DCM patients with high PAD/AoD were younger,had more frequent previous HF hospitalizations,lower blood pressure,higher BNP level,lower LVEF,smaller AoD(all P<0.01)and similar PAD(P=0.08)compared with patients with a low PAD/AoD3.Eighteen patients with DCM underwent CT and other examinations in the acute and chronic phase of HF,respectively.Comparison of related indexes between acute phase and chronic phase of HF:The BNP levels in acute and chronic phase of HF were significantly decreased(P<0.01),AoD,PAD,PAD/AoD,LVEF,systolic blood pressure were not significantly changed(all P>0.05)4.A higher PAD/AoD was associated with poorer prognosis after adjusting for age,blood pressure,number of previous HF hospitalizations,BNP or left ventricular ejection fractionConclusions:With the gradual increase of PAD/AOD in DCM patients with acute HF,the rates of cardiac death and repeated hospitalization are significantly increased,so PAD/AoD has important value in evaluating the severity of acute HF and predicting prognosis in such patients.Of course,more high-quality related studies still need to be further carried out to guide their clinical application. |
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