Prognostic value of mechanical efficiency in ambulatory patients with idiopathic dilated cardiomyopathy in sinus rhythm

Objectives The purpose of this study was to determine, by analyzing the pressure-volume relationship, the prognostic value of parameters related to myocardial energetics for predicting mortality in patients with dilated cardiomyopathy (DCM) in sinus rhythm. Background The relationship between the myocardial energetics and the prognosis of patients with DCM in sinus rhythm remains unclear. Methods We followed 114 ambulatory patients with nonischemic DCM in sinus rhythm for a mean period of 5.8 ± 3.9 years. Over 70% of our patients were in New York Heart Association functional class I and class II. Pressure-volume data were obtained by the conductance method, and myocardial oxygen consumption per beat (Vimage2) measurements were obtained. Results The 3-, 5-, and 10-year cumulative survival rates were 88.6%, 80.0%, and 73.9%, respectively. Of the 114 patients, 47 were selected randomly to assess their myocardial energetics. By univariate analysis, the mechanical efficiency (ME, external work/Vimage2), left ventricular (LV) ejection fraction and the LV end-diastolic pressure were statistically associated with cardiac death. The ME was the strongest predictor of survival in a Cox proportional-hazards analysis (p = 0.011). The best cutoff point of ME identified by the receiver-operating curve was 11%. This value had a sensitivity of 100%, a specificity of 87% and an overall predictive accuracy of 88% to distinguish survivors from nonsurvivors. Conclusions This study clearly demonstrates that ME is a powerful clinical predictor for cardiac death in patients with mild to moderate heart failure and with sinus rhythm. Whether these conclusions apply to patients with more severe heart failure requires further investigations.