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      Comparison of Clinical Course and Outcomes between Dilated and Hypokinetic Non-Dilated Cardiomyopathy

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          Abstract

          Background: By definition, dilated cardiomyopathy (DCM) is characterized by enlargement of the left ventricular (LV) cavity, and systolic dysfunction. However, in 2016 ESC introduced a new clinical entity – hypokinetic non-dilated cardiomyopathy (HNDC). HNDC is defined as LV systolic dysfunction without LV dilatation. However, the diagnosis of HNDC has so far rarely been made by a cardiologist, and it is unknown whether “classic” DCM differs from HNDC in terms of clinical course and outcomes. Objectives: Comparison of heart failure profiles and outcomes between patients with “classic” dilated (DCM) and HNDCs. Method: We retrospectively analysed 785 DCM patients, defined as impaired left ventricle (LV) systolic function (ejection fraction [LVEF] <45%) in the absence of coronary artery disease, valve disease, congenital heart disease, and severe arterial hypertension. “Classic” DCM was diagnosed when LV dilatation was present (LV end-diastolic diameter >52 mm/58 mm in women/men); otherwise, HNDC was diagnosed. After 47 ± 31 months, the all-cause mortality and composite endpoint (all-cause mortality, heart transplant – HTX, left ventricle assist device implantation – LVAD) were assessed. Results: There were 617 (79%) patients with LV dilatation. Patients with “classic” DCM differed from HNDC in terms of clinically relevant parameters [hypertension (47% vs. 64%, p = 0.008), ventricular tachyarrhythmias (29% vs. 15%, p = 0.007), NYHA class (2.5 ± 0.9 vs. 2.2 ± 0.8, p = 0.003)], had lower cholesterol (LDL: 2.9 ± 1.0 vs. 3.2 ± 1.1 mmol/L, p = 0.049), and higher N-terminal pro-brain natriuretic peptide (3,351 ± 5,415 vs. 2,563 ± 8584 pg/mL, p = 0.0001) and required higher diuretics dosages (57.8 ± 89.5 vs. 33.7 ± 48.7 mg/day, p ≤ 0.0001). All of their chambers were larger (LVEDd: 68.3 ± 4.5 vs. 52.7 ± 3.5 mm, p < 0.0001) and they had lower LVEF (25.2 ± 9.4 vs. 36.6 ± 11.7%, p < 0.0001). During the follow-up, there were 145 (18%) composite endpoints (“classic” DCM vs. HNDC: 122 [20%] vs. 26 [18%], p = 0.22): deaths (97 [16%] vs. 24 [14%], p = 0.67), HTX (17 [4%] vs. 4 [4%], p = 0.97) and LVAD (19 [5%] vs. 0 [0%], p = 0.03). Both groups did not differ in terms of all-cause mortality ( p = 0.70), cardiovascular (CV) mortality ( p = 0.37) and composite endpoint ( p = 0.26). Conclusions: LV dilatation was absent in more than one-fifth of DCM patients. HNDC patients had less severe heart failure symptoms, less advanced cardiac remodelling, and required lower diuretics dosages. On the other hand, “classic” DCM and HNDC patients did not differ in terms of all-cause mortality, CV mortality, and composite endpoint.

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          Author and article information

          Journal
          CRD
          Cardiology
          10.1159/issn.0008-6312
          Cardiology
          Cardiology
          S. Karger AG
          0008-6312
          1421-9751
          2023
          October 2023
          13 June 2023
          : 148
          : 5
          : 395-401
          Affiliations
          [_a] aDepartment of Cardiac and Vascular Diseases, Jagiellonian University Collegium Medicum, John Paul II Hospital, Krakow, Poland
          [_b] bDepartment of Cardiovascular Surgery and Transplantology, Jagiellonian University Collegium Medicum, John Paul II Hospital, Krakow, Poland
          [_c] cStudents’ Scientific Group at Department of Cardiac and Vascular Diseases, Jagiellonian University Collegium Medicum, John Paul II Hospital, Krakow, Poland
          Author information
          https://orcid.org/0000-0002-7921-5447
          https://orcid.org/0000-0002-7991-8185
          https://orcid.org/0000-0002-1094-7922
          https://orcid.org/0000-0002-6979-3411
          Article
          531534 Cardiology 2023;148:395–401
          10.1159/000531534
          37311443
          84fffb6c-01ce-4673-a52d-fca06b44bdbf
          © 2023 S. Karger AG, Basel

          Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.

          History
          : 11 December 2022
          : 31 May 2023
          Page count
          Figures: 2, Tables: 1, Pages: 7
          Funding
          This work was supported by the Department of Scientific Research and Structural Funds of Medical College, Jagiellonian University (Grant SAP N41/DBS/000594).
          Categories
          HF and Intensive Care: Short Communication

          Medicine
          Hypokinetic non-dilated cardiomyopathy,Dilated cardiomyopathy,Mortality,Left ventricle dilatation,Non-ischaemic cardiomyopathy,Survival

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