Male Patients With Dilated Cardiomyopathy Exhibiting a Higher Heart Rate Acceleration Capacity or a Lower Deceleration Capacity Are at Higher Risk of Cardiac Death.

Yichen Yang,Cao Zou,Xiangjun Yang,Xun Li,Xingmei Huang,Hongkai Dong,Bingyuan Zhou,Fengyan Wang

doi:10.3389/fphys.2018.01774

Abstract

The effects of dilated cardiomyopathy (DCM) on cardiac autonomic regulation and electrophysiology, and the consequences of such changes, remain unclear. We evaluated the associations between heart rate acceleration capacity (AC) and deceleration capacity (DC), heart structural and functional changes, and cardiac death in 202 healthy controls and 100 DCM patients. The DC was lower and the AC was higher in DCM patients (both males and females). Multivariable, linear, logistic regression analyses revealed that in males, age was positively associated with AC in healthy controls (N = 85); the left atrial diameter (LAD) was positively and the left ventricular ejection fraction (LVEF) was negatively associated with AC in DCM patients (N = 65); age was negatively associated with DC in healthy controls (N = 85); and the LAD was negatively and the LVEF was positively associated with DC in DCM patients (N = 65). In females, only age was associated with either AC or DC in healthy controls (N = 117). Kaplan–Meier analysis revealed that male DCM patients with greater LADs (≥46.5 mm) (long-rank chi-squared value = 11.1, P = 0.001), an elevated AC (≥-4.75 ms) (log-rank chi-squared value = 6.8, P = 0.009), and a lower DC (≤4.72 ms) (log-rank chi-squared value = 9.1, P = 0.003) were at higher risk of cardiac death within 60 months of follow-up. In conclusion, in males, DCM significantly affected both the AC and DC; a higher AC or a lower DC increased the risk of cardiac death.

Highlights

Dilated cardiomyopathy (DCM) is a progressive disease of the heart muscle characterized by the presence of left ventricular dilatation and systolic dysfunction (Elliott et al, 2008)
The average acceleration capacity (AC), left atrial diameter (LAD), left ventricular end-diastolic dimension (LVEDD), and LVESD were significantly higher in dilated cardiomyopathy (DCM) patients than controls; the average deceleration capacity (DC) and left ventricular ejection fraction (LVEF) were significantly lower than in controls (Table 1)
DCM patients were significant older than controls and, as with males, the average AC, LAD, LVEDD, and LVESD were significantly higher in DCM patients than controls; the average DC and LVEF were significantly lower in DCM patients (Table 1)

Summary

Introduction

Dilated cardiomyopathy (DCM) is a progressive disease of the heart muscle characterized by the presence of left ventricular dilatation and systolic dysfunction (Elliott et al, 2008). The patho-anatomical characteristics of DCM, such as heart failure, valve disease and heart blood clots, have been well studied (Elliott et al, 2008; Japp et al, 2016; Weintraub et al, 2017). A dilated heart does not pump blood effectively, and enlargement of heart chambers compromises valve function (Elliott et al, 2008; Japp et al, 2016; Weintraub et al, 2017). The effects of DCM on cardiac autonomic regulation and electrophysiology, and the consequences of such changes, remain unclear

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