Prognostische Faktoren für den Krankheitsverlauf bei Patienten mit bioptisch gesicherter inflammatorischer Kardiomyopathie aus den Jahren 2006-2011

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,...

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Bibliographic Details
Main Author: Michel, Christof
Contributors: Ohlow, Marc-Alexander (Prof. Dr. med.) (Thesis advisor)
Format: Doctoral Thesis
Language:German
Published: Philipps-Universität Marburg 2018
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Table of Contents: At this point, in the literature only a few parameters of clinical presentation (NYHA Class, syncope, blood pressure) and diagnosis (EF, bundle branch block, ventricular dysfunction) are known as factors which influence the further course of the inflammatory cardiomyopathy [26, 17, 27, 57, 66, 71, 72, 88, 120, 140, 151]. The aim of this thesis was to determine which of 71 different parameters of patients with inflammatory cardiomyopathy indicate an event-free survival in a follow-up. In this retrospective study the initial parameters of 502 patients (median age 58 years, 71.9% male) were investigated from the years 2006 to 2011. Each of the patients had a bioptically confirmed inflammatory cardiomyopathy and were treated in the clinic for cardiology of the Zentralklinik Bad Berka. In a next step 466 of 502 patients were followed up during a mean of 44 months in order to determine with bi- and multivariate analysis (Cox proportional hazard model) the parameters which have a prognostic significance over the disease course of inflammatory cardiomyopathy. The combined primary endpoint was cardiac death, survived sudden cardiac death, heart transplant (planned or performed) and implantation of a ventricular assist device. Forty-four patients (8,6%) reached the combined primary endpoint during follow-up, with 14 patients (3%) having a cardiac death. The predictors of the endpoint were an age ≥50 years, initial signs of congestive heart failure (left ventricular EF ≤30%, NYHA Class I-IV, LA diameter >39 mm, pulmonary edema), pulmonary rales and the initial occurrence of a syncope. A symptom duration of >28 days before hospitalization and pectanginous complaints (CCS Class I-IV) were investigated as favorable predictors of event-free survival. No one reached the endpoint in the follow-up in a subgroup of patients with an age <50 years, a NYHA Class 0 and a symptom duration >28 days. In contrast, 35.9% of patients with an age ≥50 years, a NYHA Class I-IV and a symptom duration ≤28 days reached the combined endpoint in the follow-up.