Publikationsserver der Universitätsbibliothek Marburg

Titel:Prognostische Faktoren für den Krankheitsverlauf bei Patienten mit bioptisch gesicherter inflammatorischer Kardiomyopathie aus den Jahren 2006-2011
Autor:Michel, Christof
Weitere Beteiligte: Ohlow, Marc-Alexander (Prof. Dr. med.)
Veröffentlicht:2018
URI:https://archiv.ub.uni-marburg.de/diss/z2018/0285
URN: urn:nbn:de:hebis:04-z2018-02856
DOI: https://doi.org/10.17192/z2018.0285
DDC: Medizin
Titel (trans.):Prognostic factors for the disease course in patients with biopsy-proven inflammatory cardiomyopathy from the years 2006-2011
Publikationsdatum:2018-06-26
Lizenz:https://creativecommons.org/licenses/by-nc-sa/4.0

Dokument

Schlagwörter:
Risikofaktoren, myocarditis, Risikofaktoren, follow-up, Kardiologie, Follow-up, cardiology, inflammatory cardiomyopathy, Follow-up, Biopsie, Myokarditis, human, risk factors, Prognose, Prädiktoren, survival analysis, Mensch, prognosis, Überlebensanalyse, Kardiologie, Biopsie, Mensch, predictors, inflammatorische Kardiomyopathie, Myokarditis, Überlebensanalyse, inflammatorische Kardiomyopathie, Prädiktoren, Prognose, biopsy

Zusammenfassung:
Als Faktoren, die Einfluss auf den weiteren Krankheitsverlauf einer inflammatorischen Kardiomyopathie haben, sind in der Literatur bisher nur wenige Parameter der klinischen Präsentation (NYHA-Stadium, Synkope, Blutdruck) und der Diagnostik (EF, Schenkelblock, Ventrikeldysfunktion) bekannt [26, 17, 27, 57, 66, 71, 72, 88, 120, 140, 151]. Ziel der vorliegenden Arbeit war es zu ermitteln inwieweit eine Bandbreite von 71 verschiedenen Aufnahmebefunden von Patienten mit inflammatorischer Kardio-myopathie jeweils eine Aussage über das ereignisfreie Überleben in einem Follow-up zulassen. In der vorliegenden retrospektiven Studie wurden die initialen Parameter von 502 Patienten (medianes Alter 58 Jahre, 71,9% männlich) aus den Jahren 2006 bis 2011 ermittelt, die eine bioptisch gesicherte inflammatorische Kardiomyopathie hatten und in der Klinik für Kardiologie der Zentralklinik Bad Berka behandelt wurden. In einem zweiten Schritt erfolgte bei 466 Personen dieser Population ein Follow-up im gemittelten Zeitraum von 44 Monaten, um mittels bi- und multivariater Cox-Regressionsanalyse jene Parameter zu ermitteln, die eine prognostische Aussagekraft über den Krankheitsverlauf der inflammatorischen Kardiomyopathie haben. Als primärer kombinierter Endpunkt galt dabei: kardialer Tod, überlebter plötzlicher Herzstillstand, Herztransplantation (geplant oder durchgeführt) und Implantation eines ventrikulären Unterstützungssystems. Im Follow-up erreichten 40 Patienten (8,6%) den primären kombinierten Endpunkt, wobei 14 Personen (3%) eines kardialen Todes starben. Als Prädiktoren des Endpunktes zeigten sich ein Alter ≥50 Jahre, initiale Zeichen der Herzinsuffizienz (linksventrikuläre EF ≤30%, NYHA-Stadium I-IV, LA-Durchmesser >39 mm, pulmonales Ödem), pulmonale Rasselgeräusche und das initiale Auftreten einer Synkope. Als günstige Prädiktoren eines ereignisfreien Überlebens erwiesen sich eine Symptomdauer >28 Tage vor Klinikaufnahme und pectanginöse Beschwerden (CCS-Stadium I-IV). In einer Subgruppe von Patienten mit einem Alter <50 Jahre, einem NYHA-Stadium 0 und einer Symptomdauer >28 Tagen erreichten 0% den Endpunkt im Follow-up. Demgegenüber erreichten 35,9% der Patienten mit einem Alter ≥50 Jahre, einem NYHA-Stadium I-IV und einer Symptomdauer ≤28 Tage den kombinierten Endpunkt im Follow-up.

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