Factors influencing the reversal of cardiac structure and function in patients with dilated cardiomyopathy

doi:10.3877/cma.j.issn.1674-6880.2021.01.004

Abstract

Abstract:

Objective

To explore the predictors for cardiac structural and functional reversal after pharmacological treatment in patients with dilated cardiomyopathy.

Methods

A total of 156 patients with dilated cardiomyopathy admitted to Xuzhou Central Hospital from August 2016 to April 2017 were retrospectively analyzed. According to their clinical outcomes and different reactivity of echocardiographic findings after treatment, 156 patients were divided into a left ventricular reverse remodeling (LVRR) group (n=27) and a non-LVRR group (n=129). The age, sex, body mass index, course of disease, systolic blood pressure, New York Heart Association grade, hypertension, diabetes, atrial fibrillation, angiotensin converting enzyme inhibitor/angiotensin receptor blocker, β receptor blocker, spironolactone, complete left bundle branch block, QRS wave time limit, N-terminal pro-brain natriuretic peptide, left ventricular ejection fraction, left ventricular end-diastolic dimension, left ventricular end-systolic volume index, 6-min walk test, medication compliance, 6-month rehospitalization rate and 6-month mortality rate were recorded for all patients. Multivariate Logistic regression was used to analyze factors related to LVRR in patients with dilated cardiomyopathy. Receiver operating characteristic (ROC) curves were used to evaluate predictive value of QRS wave time limit and medication compliance in LVRR.

Results

Compared with the non-LVRR group, the age [(54±16) years vs. (60 ± 12) years, t=5.899, P=0.021] and QRS wave time limit [(104 ± 21) ms vs. (122 ± 29) ms, t=10.464, P=0.003] were significantly lower and the medication compliance [(6.0 ± 1.0) vs. (5.3 ± 1.5), t=8.962, P=0.002] was significantly higher in the LVRR group. The multivariate Logistic regression showed that the QRS wave time limit [odds ratio (OR)=0.969, 95% confidence interval (CI) (0.946, 0.993), P=0.011] and medication compliance [OR=1.541, 95%CI (1.064, 2.230), P=0.022] were independent factors affecting the return to normal cardiac function. The ROC curve showed that the QRS wave time limit [area under the curve (AUC)=0.721, 95%CI (0.619, 0.824), P < 0.001] and medication compliance [AUC=0.661, 95%CI (0.559, 0.762), P < 0.009] both have predictive value for LVRR in patients with dilated cardiomyopathy.

Conclusion

QRS wave time limit and medication compliance are important predictors for LVRR in patients with dilated cardiomyopathy.

Key words: Cardiomyopathy, dilated, Left ventricular reverse remodeling, Predictor

Hui Xu, Zhigang Li, Yan Zhao, Xiaoli Li, Bing Han. Factors influencing the reversal of cardiac structure and function in patients with dilated cardiomyopathy[J]. Chinese Journal of Critical Care Medicine(Electronic Edition), 2021, 14(01): 20-24.

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References 20

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组别	例数	年龄（岁）	性别（例，男/女）	BMI（kg/m²）	病程[年，M（P₂₅，P₇₅）]	收缩压（mmHg）	NYHA分级（例）
组别	例数	年龄（岁）	性别（例，男/女）	BMI（kg/m²）	病程[年，M（P₂₅，P₇₅）]	收缩压（mmHg）	Ⅱ	Ⅲ	Ⅳ
LVRR组	27	54 ± 16	19/8	26 ± 3	3.0（0.5，4.0）	121 ± 18	6	13	8
非LVRR组	129	60 ± 12	91/38	25 ± 4	4.0（1.3，6.0）	119 ± 15	35	66	28
t/χ²/H值		5.899	0.000	1.211	1.570	2.216	0.852
P值		0.021	0.986	0.173	0.116	0.563	0.653
组别	例数	高血压（例）	糖尿病（例）	心房颤动（例）	ACEI/ARB（例）	β受体阻滞剂（例）	螺内酯（例）	NT-proBNP [ng/L，M（P₂₅，P₇₅）]
LVRR组	27	7	1	4	26	25	26	867.70（359.20，1 958.30）
非LVRR组	129	36	18	32	122	119	123	948.70（372.30，1 694.90）
t/χ²/H值		0.044	2.193	1.256	0.765	0.070	0.047	0.316
P值		0.834	0.139	0.262	0.682	0.966	0.829	0.752
组别	例数	CLBBB（例）	QRS波时限（ms）	LVEF（%）	LVEDD（mm）	LVESVI（mL）	6MWT（m）	服药依从性（分）
LVRR组	27	2	104 ± 21	31 ± 8	67 ± 8	135 ± 54	308 ± 52	6.0 ± 1.0
非LVRR组	129	27	122 ± 29	31 ± 6	69 ± 9	144 ± 48	304 ± 71	5.3 ± 1.5
t/χ²/H值		5.623	10.464	8.427	0.173	0.112	4.479	8.962
P值		0.060	0.003	0.723	0.301	0.367	0.732	0.002

组别	例数	年龄（岁）	性别（例，男/女）	BMI（kg/m²）	病程[年，M（P₂₅，P₇₅）]	收缩压（mmHg）	NYHA分级（例）
组别	例数	年龄（岁）	性别（例，男/女）	BMI（kg/m²）	病程[年，M（P₂₅，P₇₅）]	收缩压（mmHg）	Ⅱ	Ⅲ	Ⅳ
LVRR组	27	54 ± 16	19/8	26 ± 3	3.0（0.5，4.0）	121 ± 18	6	13	8
非LVRR组	129	60 ± 12	91/38	25 ± 4	4.0（1.3，6.0）	119 ± 15	35	66	28
t/χ²/H值		5.899	0.000	1.211	1.570	2.216	0.852
P值		0.021	0.986	0.173	0.116	0.563	0.653
组别	例数	高血压（例）	糖尿病（例）	心房颤动（例）	ACEI/ARB（例）	β受体阻滞剂（例）	螺内酯（例）	NT-proBNP [ng/L，M（P₂₅，P₇₅）]
LVRR组	27	7	1	4	26	25	26	867.70（359.20，1 958.30）
非LVRR组	129	36	18	32	122	119	123	948.70（372.30，1 694.90）
t/χ²/H值		0.044	2.193	1.256	0.765	0.070	0.047	0.316
P值		0.834	0.139	0.262	0.682	0.966	0.829	0.752
组别	例数	CLBBB（例）	QRS波时限（ms）	LVEF（%）	LVEDD（mm）	LVESVI（mL）	6MWT（m）	服药依从性（分）
LVRR组	27	2	104 ± 21	31 ± 8	67 ± 8	135 ± 54	308 ± 52	6.0 ± 1.0
非LVRR组	129	27	122 ± 29	31 ± 6	69 ± 9	144 ± 48	304 ± 71	5.3 ± 1.5
t/χ²/H值		5.623	10.464	8.427	0.173	0.112	4.479	8.962
P值		0.060	0.003	0.723	0.301	0.367	0.732	0.002

影响因素	回归系数	标准误	Wald值	P值	OR值	95%CI
年龄（岁）	-0.028	0.016	3.044	0.081	0.972	0.942 ~ 1.003
QRS波时限（ms）	-0.032	0.012	6.414	0.011	0.969	0.946 ~ 0.993
服药依从性（分）	0.432	0.189	5.249	0.022	1.541	1.064 ~ 2.230

影响因素	回归系数	标准误	Wald值	P值	OR值	95%CI
年龄（岁）	-0.028	0.016	3.044	0.081	0.972	0.942 ~ 1.003
QRS波时限（ms）	-0.032	0.012	6.414	0.011	0.969	0.946 ~ 0.993
服药依从性（分）	0.432	0.189	5.249	0.022	1.541	1.064 ~ 2.230

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