Differences in Clinical Features, Hemodynamic Findings and Clinical Outcomes of Ischemic and Non-ischemic Cardiomyopathy in End-Stage Heart Failure
Zubeyde Bayram1, Süleyman Cagan Efe1, Ali Karagoz1, Cem Dogan1, Busra Guvendi1, Samet Uysal1, Rezzan Deniz Acar1, Ozgur Yasar Akbal1, Fatih Yilmaz1, Hacer Ceren Tokgoz1, Mehmet Kaan Kirali2, Cihangir Kaymaz1, Nihal Ozdemir1
1Kosuyolu Heart Training And Research Hospital, Cardiology, Istanbul, Turkey
2Kosuyolu Heart Training And Research Hospital, Cardiovascular Surgery, Istanbul, Turkey
Keywords: clinical outcome, heart failure etiology, ischemic cardiomyopathy, non-ischemic cardiomyopathy, right ventricular function
Objectives: The aim of this study was to investigate the effect of heart failure (HF) etiology on clinical, echocardiographic, and hemodynamic findings, right ventricular (RV) function, and outcomes in patients with end-stage HF.
Patients and Methods: A total of 470 end-stage HF patients who undergoing evaluation for heart transplantation (HT) were divided into two groups: ischemic cardiomyopathy (ICMP, n=249) and nonischemic cardiomyopathy (NICMP, n=221). RV dysfunction was defined as tricuspid annular plane systolic excursion (TAPSE) ≤1.5 cm (TAPSE-defined RV dysfunction) and right ventricular stroke work index (RVSWI) <5 g/m/beat/m2 (RVSWI-defined RV dysfunction). The primary outcome was defined as left ventricular assist device implantation, urgent HT, or death.
Results: Patients with ICMP had higher pulmonary vascular resistance, systolic and mean pulmonary artery pressures (PAPs and PAPm) than those with NICMP [3.0 (1.1-6.0) vs. 2.0 (1.0-5.0),P=0.013; 53.5 (42.0-68.0) vs. 46.0 (32.5-64.5),P <0.001 and 35.512.9 vs. 31.812.3,P=0.002]. RVSWI levels were lower in NICMP patients than in ICMP patients [5.4 (3.7-7.6) vs. 6.5 (4.6-9.6),P <0.001]. While TAPSE-defined RV dysfunction was comparable between NICMP and ICMP, RVSWI-defined RV dysfunction was higher in NICMP (44.3% vs. 55.0%,P=0.069 and 45.2% vs. 31.3%,P=0.012). NICMP was an independent predictor for RVSWI-defined RV dysfunction, but not for TAPSE-defined RV dysfunction, according to multivariate analyses (OR:1.79, 95% CI:1.13-2.82,P=0.012 and OR:0.63, 95% CI:0.28-1.39,P=0.254). Over a median follow-up of 503.5 days, it was demonstrated that HF etiology was not a predictor of primary outcome according to unadjusted and adjusted models (OR:0.99, 95% CI:0.80-1.23,P=0.936 ve OR:0.89, 95% CI:0.60-1.31,P=0.542).
Conclusion: We that demonstrated patients with end-stage HF, ICMP had greater RV afterload and RVSWI value than NICMP and HF etiology was not predictor of primary outcome. However, we couldn't say for sure whether HF etiology has an effect on RV function because of the conflicting results in TAPSE-defined RV dysfunction and RVSWI-defined RV dysfunction.