TEN-YEAR FOLLOW-UP OF PATIENTS WITH UNEXPLAINED LEFT VENTRICULAR SYSTOLIC DYSFUNCTION EVALUATED BY ENDOMYOCARDIAL BIOPSY
Topic: Myocardial and pericardial diseases | |
| Type: Presentation - doctors , Number in the programme: 75 | |
| Enlisted in: Young investigator awards | |
| Habásko J.1, Marek J.1, Kuchynka P.1, Podzimková J.1, Danek B.1, Roblová L.1, Chocholová B.1, Vítková I.2, Kreidlová M.3, Kyšperská K.1, Kovárník T.1, Šimek S.1, Horák J.1, Linhart A.1, Paleček T.1 1 II. interní klinika - klinika kardiologie a angiologie, Všeobecná fakultní nemocnice v Praze, Prague, 2 Ústav patologie, Všeobecná fakultní nemocnice v Praze, Prague, 3 Ústav lékařské biochemie a laboratorní diagnostiky, Všeobecná fakultní nemocnice v Praze, Prague | |
Background and aims: The long-term prognosis of patients with recent-onset left ventricular dysfunction (LVSD) is variable. The role of endomyocardial biopsy (EMB) and clinical predictors including left ventricular reverse remodelling (LVRR) in these patients is still unclear. Our study aimed to analyse the prognostic role of LVRR and EMB, along with other clinical baseline data during a ten-year follow-up of these patients. Methods: We prospectively evaluated 133 patients (37 women; 55 [46, 61] years) that underwent EMB for recently diagnosed unexplained LVSD at our centre between 2007 and 2013. LVRR was evaluated at year one after baseline. Regarding baseline predictors of prognosis, mortality and heart transplantation were used as endpoints. Results: During the ten-year follow-up period, 27% of individuals died and 3% underwent heart transplantation. There were 51 heart failure hospitalisations in 27 individuals. 35 episodes of ICD/CRT-D therapy were recorded in 13 individuals (33% of ICD/CRT-D recipients). In multivariate analysis, baseline right atrial area and neutrophile-lymphocyte ratio were identified as statistically significant predictors of ten-year mortality and heart transplantation (all p < 0.01). LVRR was documented in 46% and was associated with a reduced risk of the combined endpoint comprised of death, heart transplantation and ICD/CRT-D therapy (p = 0.002). Conclusions: Achievement of LVRR was strongly related to the long-term prognosis of patients with recently diagnosed unexplained LVSD. Furthermore, our study demonstrates the importance of right heart involvement and subclinical systemic inflammation for the long-term prognosis of these patients. Neither the presence of EMB-proved myocarditis by immunohistochemical criteria nor the presence of viral agents in EMB predicted outcome. | |
