323 Assessment of mitral annulus dilatation in patients with primary dilated cardiomyopathy before and after posterior semicircular reductive annuloplasty

Aetiology of ischemic heart disease has been shown to be associated with worse prognosis than idiopathic aetiology in patients with chronic heart failure. Other reports showed that survival was worse for idiopathic dilated cardiomyopathy or was unrelated to aetiology. Due to these conflicting results, large therapeutic multicentre heart failure trials included patients regardless of aetiology. We hypothesized that patient group selection bias, for example the study of heart transplant candidates, may explain these conflicting results. To determine whether ischemic or idiopathic causes of cardiomyopathy were associated with prognosis, 287 patients with LV ejection fraction (EF) 6.0cm were followed prospectively. LVEF was assessed by visual estimation, M-mode echo (when there were no regional wall motion abnormalities or left bundle branch block), Simpson’s rule and systolic mitral annular velocity. Patients had invasively proven ischemic or idiopathic dilated cardiomyopathy. Advances in medical therapy were systematically implemented over a mean follow-up period of 3.7±3.3 years. The cause was idiopathic in 52% of patients and ischemic in 48%. There was no significant difference in age (45±13 versus 48±18years), sex (male 68 versus 71%), LVEF (24± 8v ersus 25±7%) and LV end diastolic diameter (7.0±1.0 versus 6.8±0.8cm) between idiopathic and ischemic cardiomyopathy patients. When patients with heart transplantation were considered as deaths (n=43), there was no significant difference in total mortality between the 2 groups (p= 0.65 logrank test). With multiple logistic regression analysis, NYHA functional class and LVEF were identified as the variables most closely associated with mortality (p=0.007 and 0.03 respectively) among patients with idiopathic cardiomyopathy. In ischemic patients, only peak oxygen consumption was related to mortality (p=0.01). Left bundle branch block or QRS duration >120ms failed to predict outcome. Conclusion: Aetiology of ischemic heart disease was not an independent predictor of mortality in patients with severe chronic heart failure in this prospective study.