RT Journal Article
SR Electronic
T1 Results of comprehensive diagnostic work-up in ‘idiopathic’ dilated cardiomyopathy
JF Open Heart
JO Open Heart
FD British Cardiovascular Society
SP e000271
DO 10.1136/openhrt-2015-000271
VO 2
IS 1
A1 Kaspar Broch
A1 Arne K Andreassen
A1 Einar Hopp
A1 Trond P Leren
A1 Helge Scott
A1 Fredrik Müller
A1 Svend Aakhus
A1 Lars Gullestad
YR 2015
UL http://openheart.bmj.com/content/2/1/e000271.abstract
AB Objective Dilated cardiomyopathy (DCM) is characterised by left ventricular dilation and dysfunction not caused by coronary disease, valvular disease or hypertension. Owing to the considerable aetiological and prognostic heterogeneity in DCM, an extensive diagnostic work-up is recommended. We aimed to assess the value of diagnostic testing beyond careful physical examination, blood tests, echocardiography and coronary angiography.Methods From October 2008 to November 2012, we prospectively recruited 102 patients referred to our tertiary care hospital with a diagnosis of ‘idiopathic’ DCM based on patient history, physical examination, routine blood tests, echocardiography and coronary angiography. Extended work-up included cardiac MRI, exercise testing, right-sided catheterisation with biopsies, 24 h ECG and genetic testing.Results In 15 patients (15%), a diagnosis other than ‘idiopathic’ DCM was made based on additional tests. In 10 patients (10%), a possibly disease-causing mutation was detected. 2 patients were found to have non-compaction cardiomyopathy based on MRI findings; 2 patients had systemic inflammatory disease with cardiac involvement; and in 1 patient, cardiac amyloidosis was diagnosed by endomyocardial biopsy. Only in 5 cases did the results of the extended work-up have direct therapeutic consequences.Conclusions In patients with DCM, in whom patient history and routine work-up carry no clues to the aetiology, the diagnostic and therapeutic yield of extensive additional testing is modest.