Left Ventricular Function and Hypertrophy in Cardiomyopathy with Depressed Ejection Fraction

Abstract

Left ventricular (LV) function and hypertrophy, assessed during cardiac catheterization by quantitative biplane angiocardiography, were related to postcatheterization course in 36 patients found to have cardiomyopathy with depressed ejection fraction (EF). EF ranged from 0.09 to 0.41, LV mass (M) from 99 to 317 g/m 2 , LV end-diastolic volume (V) from 104 to 347 ml/m 2 , and ratio of M/V from 0.66 to 1.63. In this study, EF was used as an index of LV function; M/V ratio was considered to represent a relative degree of LV hypertrophy. Postcatheterization survival rates (PCSR) for all patients at 12, 24, and 36 months were 68.8 ± 7.8%, 49.9 ± 9.2%, and 32.8 ± 10.2%. The 36-month PCSR was significantly higher for patients (N = 15) with EF ≥ 0.20 (75.1 ± 14.5%) than for those (N = 21) with EF < 0.20 (0%) ( P < 0.01). The 36-month PCSR was also significantly higher for patients (N = 19) with M/V ratio ≥ 0.90 (53.6 ± 14.8%) than for those (N = 17) with M/V ratio < 0.90 (12.4 ± 10.4%) ( P < 0.05). M/V ratio appeared to influence survival at least in part independently of EF. For patients with EF ≥0.20 M/V ratio ≥ 0.90 was associated with a higher 36-month PCSR (100%) than was M/V ratio < 0.90 (25.0 ± 6.5%). Likewise, for patients with EF < 0.20, M/V ratio ≥ 0.90 was associated with a higher 24-month PCSR (65.1 ± 16.8%) than was M/V ratio < 0.90 (6.8 ± 9.1%); but at 36 months, PCSR was < 10% for both subgroups. Patients (N = 16) with mitral regurgitation (MR) > 0.70 liters/min/m 2 had a mean value for V (212.9 ± 74.1 ml/m 2 ) significantly larger than for those (N = 20) without MR or with MR < 0.70 liters/min/m 2 (168.8 ± 40.7 ml/m 2 ) ( P = 0.0278). Although this suggests that dilatation of the mitral valve annulus contributed to the development of the regurgitation, the large overlap in V values implies that additional mechanisms played a role. This study describes quantitatively a spectrum of hemodynamic abnormalities in patients who had cardiomyopathy with depressed EF, and demonstrates that the present series of patients had a high postcatheterization mortality rate. Both EF and M/V ratio were of prognostic value and thus appear to be useful indices for classifying such patients.