FREE NEJM E-TOC    HOME   |   SUBSCRIBE   |   CURRENT ISSUE   |   PAST ISSUES   |   COLLECTIONS   |   Search Term  Advanced Search

Sign in | Get NEJM's E-Mail Table of Contents — Free | Subscribe

Previous Volume 342:1077-1084 April 13, 2000 Number 15 Next

	Full Text PDF Editorial by Givertz, M. M. Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

ABSTRACT

Background Previous studies of the prognosis of patients with heart failure due to cardiomyopathy categorized patients according to whether they had ischemic or nonischemic disease. The prognostic value of identifying more specific underlying causes of cardiomyopathy is unknown.

Methods We evaluated the outcomes of 1230 patients with cardiomyopathy. The patients were grouped into the following categories according to underlying cause: idiopathic cardiomyopathy (616 patients); peripartum cardiomyopathy (51); and cardiomyopathy due to myocarditis (111), ischemic heart disease (91), infiltrative myocardial disease (59), hypertension (49), human immunodeficiency virus (HIV) infection (45), connective-tissue disease (39), substance abuse (37), therapy with doxorubicin (15), and other causes (117). Cox proportional-hazards analysis was used to assess the association between the underlying cause of cardiomyopathy and survival.

Results During a mean follow-up of 4.4 years, 417 patients died and 57 underwent cardiac transplantation. As compared with the patients with idiopathic cardiomyopathy, the patients with peripartum cardiomyopathy had better survival (adjusted hazard ratio for death, 0.31; 95 percent confidence interval, 0.09 to 0.98), and survival was significantly worse among the patients with cardiomyopathy due to infiltrative myocardial disease (adjusted hazard ratio, 4.40; 95 percent confidence interval, 3.04 to 6.39), HIV infection (adjusted hazard ratio, 5.86; 95 percent confidence interval, 3.92 to 8.77), therapy with doxorubicin (adjusted hazard ratio, 3.46; 95 percent confidence interval, 1.67 to 7.18), and ischemic heart disease (adjusted hazard ratio, 1.52; 95 percent confidence interval, 1.07 to 2.17).

Conclusions The underlying cause of heart failure has prognostic value in patients with unexplained cardiomyopathy. Patients with peripartum cardiomyopathy appear to have a better prognosis than those with other forms of cardiomyopathy. Patients with cardiomyopathy due to infiltrative myocardial diseases, HIV infection, or doxorubicin therapy have an especially poor prognosis.

Source Information

From the Division of Cardiology, Department of Medicine (G.M.F., J.M.H., D.E.C., D.L.H., K.L.B., E.K.K.), and the Department of Pathology (R.H.H.), Johns Hopkins University School of Medicine; and the Department of Biostatistics, Johns Hopkins School of Public Health and Hygiene (R.E.T.) — both in Baltimore.

Address reprint requests to Dr. Kasper at the Division of Cardiology, Johns Hopkins Hospital, Carnegie 568, 600 N. Wolfe St., Baltimore, MD 21287-6568, or at ekasper{at}jhmi.edu.

Full Text of this Article

This article has been cited by other articles:

• Chen, L., Gong, Q., Stice, J. P., Knowlton, A. A. (2009). Mitochondrial OPA1, apoptosis, and heart failure. Cardiovasc Res 84: 91-99 [Abstract] [Full Text]  
• Brauch, K. M., Karst, M. L., Herron, K. J., de Andrade, M., Pellikka, P. A., Rodeheffer, R. J., Michels, V. V., Olson, T. M. (2009). Mutations in ribonucleic Acid binding protein gene cause familial dilated cardiomyopathy.. J Am Coll Cardiol 54: 930-941 [Abstract] [Full Text]  
• Cresci, S., Kelly, R. J., Cappola, T. P., Diwan, A., Dries, D., Kardia, S. L.R., Dorn, G. W. II (2009). Clinical and genetic modifiers of long-term survival in heart failure.. J Am Coll Cardiol 54: 432-444 [Abstract] [Full Text]  
• Medi, C., Kalman, J. M., Haqqani, H., Vohra, J. K., Morton, J. B., Sparks, P. B., Kistler, P. M. (2009). Tachycardia-mediated cardiomyopathy secondary to focal atrial tachycardia: long-term outcome after catheter ablation.. J Am Coll Cardiol 53: 1791-1797 [Abstract] [Full Text]  
• RAMARAJ, R., SORRELL, V. L. (2009). Peripartum cardiomyopathy: Causes, diagnosis, and treatment. Cleveland Clinic Journal of Medicine 76: 289-296 [Abstract] [Full Text]  
• Yumino, D, Wang, H, Floras, J S, Newton, G E, Mak, S, Ruttanaumpawan, P, Parker, J D, Bradley, T D (2009). Relationship between sleep apnoea and mortality in patients with ischaemic heart failure. Heart 95: 819-824 [Abstract] [Full Text]  
• Chrustowicz, A., Simonis, G., Matschke, K., Strasser, R. H., Gackowski, A. (2009). Right ventricular dilatation predicts survival after mitral valve repair in patients with impaired left ventricular systolic function. Eur J Echocardiogr 10: 309-313 [Abstract] [Full Text]  
• de Jong, J. S.S.G., Rietveld, K., van Lochem, L. T., Bouma, B. J. (2009). Rapid left ventricular recovery after cabergoline treatment in a patient with peripartum cardiomyopathy. Eur J Heart Fail 11: 220-222 [Abstract] [Full Text]  
• Rossi, J. S., Flaherty, J. D., Fonarow, G. C., Nunez, E., Gattis Stough, W., Abraham, W. T., Albert, N. M., Greenberg, B. H., O'Connor, C. M., Yancy, C. W., Young, J. B., Davidson, C. J., Gheorghiade, M. (2008). Influence of coronary artery disease and coronary revascularization status on outcomes in patients with acute heart failure syndromes: A report from OPTIMIZE-HF (Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure). Eur J Heart Fail 10: 1215-1223 [Abstract] [Full Text]  
• Calvin, A. D., Geske, J. B., Bell, M. R. (2008). 69-Year-Old Woman With Rapid Heartbeat. Mayo Clin Proc. 83: 1392-1395 [Full Text]  
• le Polain de Waroux, J.-B., Pouleur, A.-C., Goffinet, C., Pasquet, A., Vanoverschelde, J.-L., Gerber, B. L. (2008). Combined coronary and late-enhanced multidetector-computed tomography for delineation of the etiology of left ventricular dysfunction: comparison with coronary angiography and contrast-enhanced cardiac magnetic resonance imaging. Eur Heart J 29: 2544-2551 [Abstract] [Full Text]  
• Leonardi, B., Margossian, R., Colan, S. D., Powell, A. J. (2008). Relationship of magnetic resonance imaging estimation of myocardial iron to left ventricular systolic and diastolic function in thalassemia.. J Am Coll Cardiol Img 1: 572-578 [Abstract] [Full Text]  
• Kindermann, I., Kindermann, M., Kandolf, R., Klingel, K., Bultmann, B., Muller, T., Lindinger, A., Bohm, M. (2008). Predictors of Outcome in Patients With Suspected Myocarditis. Circulation 118: 639-648 [Abstract] [Full Text]  
• Dorn, G. W. II, Matkovich, S. J. (2008). Put Your Chips on Transcriptomics. Circulation 118: 216-218 [Full Text]  
• Heidecker, B., Kasper, E. K., Wittstein, I. S., Champion, H. C., Breton, E., Russell, S. D., Kittleson, M. M., Baughman, K. L., Hare, J. M. (2008). Transcriptomic Biomarkers for Individual Risk Assessment in New-Onset Heart Failure. Circulation 118: 238-246 [Abstract] [Full Text]  
• Dube, M. P., Lipshultz, S. E., Fichtenbaum, C. J., Greenberg, R., Schecter, A. D., Fisher, S. D., for Working Group 3, (2008). Effects of HIV Infection and Antiretroviral Therapy on the Heart and Vasculature. Circulation 118: e36-e40 [Full Text]  
• Wu, K. C., Weiss, R. G., Thiemann, D. R., Kitagawa, K., Schmidt, A., Dalal, D., Lai, S., Bluemke, D. A., Gerstenblith, G., Marban, E., Tomaselli, G. F., Lima, J. A.C. (2008). Late gadolinium enhancement by cardiovascular magnetic resonance heralds an adverse prognosis in nonischemic cardiomyopathy.. J Am Coll Cardiol 51: 2414-2421 [Abstract] [Full Text]  
• Takeda, K., Matsumiya, G., Matsue, H., Sakaki, M., Sakaguchi, T., Fujita, T., Sawa, Y. (2008). Left Ventricular Reconstructive Surgery in Ischemic Dilated Cardiomyopathy Complicated With Cardiogenic Shock. Ann. Thorac. Surg. 85: 1339-1343 [Abstract] [Full Text]  
• Cooper, L. T., Baughman, K. L., Feldman, A. M., Frustaci, A., Jessup, M., Kuhl, U., Levine, G. N., Narula, J., Starling, R. C., Towbin, J., Virmani, R. (2007). The role of endomyocardial biopsy in the management of cardiovascular disease: A Scientific Statement from the American Heart Association, the American College of Cardiology, and the European Society of Cardiology Endorsed by the Heart Failure Society of America and the Heart Failure Association of the European Society of Cardiology. Eur Heart J 28: 3076-3093 [Full Text]  
• Cooper, L. T., Baughman, K. L., Feldman, A. M., Frustaci, A., Jessup, M., Kuhl, U., Levine, G. N., Narula, J., Starling, R. C., Towbin, J., Virmani, R. (2007). The Role of Endomyocardial Biopsy in the Management of Cardiovascular Disease: A Scientific Statement From the American Heart Association, the American College of Cardiology, and the European Society of Cardiology Endorsed by the Heart Failure Society of America and the Heart Failure Association of the European Society of Cardiology. J Am Coll Cardiol 50: 1914-1931 [Full Text]  
• Cooper, L. T., Baughman, K. L., Feldman, A. M., Frustaci, A., Jessup, M., Kuhl, U., Levine, G. N., Narula, J., Starling, R. C., Towbin, J., Virmani, R., Endorsed by the Heart Failure Society of America a, (2007). The Role of Endomyocardial Biopsy in the Management of Cardiovascular Disease: A Scientific Statement From the American Heart Association, the American College of Cardiology, and the European Society of Cardiology. Circulation 116: 2216-2233 [Full Text]  
• Mayosi, B. M (2007). Contemporary trends in the epidemiology and management of cardiomyopathy and pericarditis in sub-Saharan Africa. Heart 93: 1176-1183 [Abstract] [Full Text]  
• Caforio, A. L.P., Calabrese, F., Angelini, A., Tona, F., Vinci, A., Bottaro, S., Ramondo, A., Carturan, E., Iliceto, S., Thiene, G., Daliento, L. (2007). A prospective study of biopsy-proven myocarditis: prognostic relevance of clinical and aetiopathogenetic features at diagnosis. Eur Heart J 28: 1326-1333 [Abstract] [Full Text]  
• Assomull, R. G., Prasad, S. K., Lyne, J., Smith, G., Burman, E. D., Khan, M., Sheppard, M. N., Poole-Wilson, P. A., Pennell, D. J. (2006). Cardiovascular Magnetic Resonance, Fibrosis, and Prognosis in Dilated Cardiomyopathy. J Am Coll Cardiol 48: 1977-1985 [Abstract] [Full Text]  
• Zannad, F., Mebazaa, A., Juilliere, Y., Cohen-Solal, A., Guize, L., Alla, F., Rouge, P., Blin, P., Barlet, M.-H., Paolozzi, L., Vincent, C., Desnos, M., Samii, K., for the EFICA Investigators, (2006). Clinical profile, contemporary management and one-year mortality in patients with severe acute heart failure syndromes: The EFICA study. Eur J Heart Fail 8: 697-705 [Abstract] [Full Text]  
• Ginsburg, G. S., Seo, D., Frazier, C. (2006). Microarrays Coming of Age in Cardiovascular Medicine: Standards, Predictions, and Biology. J Am Coll Cardiol 48: 1618-1620 [Full Text]  
• Marcu, C. B., Beek, A. M., van Rossum, A. C. (2006). Clinical applications of cardiovascular magnetic resonance imaging.. CMAJ 175: 911-917 [Abstract] [Full Text]  
• Toyama, M., Usui, A., Abe, T., Oshima, H., Akita, T., Ueda, Y. (2006). Mitral Valve Surgery for Dilated Cardiomyopathy with Mitral Regurgitation. Asian Cardiovasc. Thorac. Ann. 14: 371-376 [Abstract] [Full Text]  
• Sola, S., Khan, B. V. (2006). Reply. J Am Coll Cardiol 48: 1284-1284 [Full Text]  
• Gheorghiade, M., Sopko, G., De Luca, L., Velazquez, E. J., Parker, J. D., Binkley, P. F., Sadowski, Z., Golba, K. S., Prior, D. L., Rouleau, J. L., Bonow, R. O. (2006). Navigating the Crossroads of Coronary Artery Disease and Heart Failure. Circulation 114: 1202-1213 [Full Text]  
• Guarneri, V., Lenihan, D. J., Valero, V., Durand, J.-B., Broglio, K., Hess, K. R., Michaud, L. B., Gonzalez-Angulo, A. M., Hortobagyi, G. N., Esteva, F. J. (2006). Long-Term Cardiac Tolerability of Trastuzumab in Metastatic Breast Cancer: The M.D. Anderson Cancer Center Experience. JCO 24: 4107-4115 [Abstract] [Full Text]  
• Kadish, A., Schaechter, A., Subacius, H., Thattassery, E., Sanders, W., Anderson, K. P., Dyer, A., Goldberger, J., Levine, J. (2006). Patients With Recently Diagnosed Nonischemic Cardiomyopathy Benefit From Implantable Cardioverter-Defibrillators. J Am Coll Cardiol 47: 2477-2482 [Abstract] [Full Text]  
• Purek, L, Laule-Kilian, K, Christ, A, Klima, T, Pfisterer, M E, Perruchoud, A P, Mueller, C (2006). Coronary artery disease and outcome in acute congestive heart failure. Heart 92: 598-602 [Abstract] [Full Text]  
• Magnani, J. W., Dec, G. W. (2006). Myocarditis: Current Trends in Diagnosis and Treatment. Circulation 113: 876-890 [Full Text]  
• Sliwa, K., Forster, O., Libhaber, E., Fett, J. D., Sundstrom, J. B., Hilfiker-Kleiner, D., Ansari, A. A. (2006). Peripartum cardiomyopathy: inflammatory markers as predictors of outcome in 100 prospectively studied patients. Eur Heart J 27: 441-446 [Abstract] [Full Text]  
• Baughman, K. L. (2006). Diagnosis of Myocarditis: Death of Dallas Criteria. Circulation 113: 593-595 [Full Text]  
• Mahrholdt, H., Wagner, A., Judd, R. M., Sechtem, U., Kim, R. J. (2005). Delayed enhancement cardiovascular magnetic resonance assessment of non-ischaemic cardiomyopathies. Eur Heart J 26: 1461-1474 [Abstract] [Full Text]  
• Kittleson, M. M., Minhas, K. M., Irizarry, R. A., Ye, S. Q., Edness, G., Breton, E., Conte, J. V., Tomaselli, G., Garcia, J. G. N., Hare, J. M. (2005). Gene expression analysis of ischemic and nonischemic cardiomyopathy: shared and distinct genes in the development of heart failure. Physiol. Genomics 21: 299-307 [Abstract] [Full Text]  
• Elkayam, U., Akhter, M. W., Singh, H., Khan, S., Bitar, F., Hameed, A., Shotan, A. (2005). Pregnancy-Associated Cardiomyopathy: Clinical Characteristics and a Comparison Between Early and Late Presentation. Circulation 111: 2050-2055 [Abstract] [Full Text]  
• Osterziel, K. J., Perrot, A. (2005). Dilated cardiomyopathy: more genes means more phenotypes. Eur Heart J 26: 751-754 [Full Text]  
• (2005). A mother's heartache: peripartum cardiomyopathy. Heart 91: 552-552 [Full Text]  
• Kittleson, M. M., Ye, S. Q., Irizarry, R. A., Minhas, K. M., Edness, G., Conte, J. V., Parmigiani, G., Miller, L. W., Chen, Y., Hall, J. L., Garcia, J. G.N., Hare, J. M. (2004). Identification of a Gene Expression Profile That Differentiates Between Ischemic and Nonischemic Cardiomyopathy. Circulation 110: 3444-3451 [Abstract] [Full Text]  
• Chan, S., Davidson, N., Juozaityte, E., Erdkamp, F., Pluzanska, A., Azarnia, N., Lee, L. W. (2004). Phase III trial of liposomal doxorubicin and cyclophosphamide compared with epirubicin and cyclophosphamide as first-line therapy for metastatic breast cancer. Ann Oncol 15: 1527-1534 [Abstract] [Full Text]  
• Wang, A., Bashore, T. M. (2004). Undercover and Overlooked. NEJM 351: 1014-1019 [Full Text]  
• Ray, P., Murphy, G. J., Shutt, L. E. (2004). Recognition and management of maternal cardiac disease in pregnancy. Br J Anaesth 93: 428-439 [Abstract] [Full Text]  
• Cade, W T., Peralta, L., Keyser, R. E (2004). Aerobic Exercise Dysfunction in Human Immunodeficiency Virus: A Potential Link to Physical Disability. ptjournal 84: 655-664 [Full Text]  
• Walker, N L, Cobbe, S M, Birnie, D H (2004). Tachycardiomyopathy: a diagnosis not to be missed. Heart 90: e7-7 [Abstract] [Full Text]  
• Michels, V V, Driscoll, D J, Miller, F A, Olson, T M, Atkinson, E J, Olswold, C L, Schaid, D J (2003). Progression of familial and non-familial dilated cardiomyopathy: long term follow up. Heart 89: 757-761 [Abstract] [Full Text]  
• Limat, S., Demesmay, K., Voillat, L., Bernard, Y., Deconinck, E., Brion, A., Sabbah, A., Woronoff-Lemsi, M. C., Cahn, J. Y. (2003). Early cardiotoxicity of the CHOP regimen in aggressive non-Hodgkin's lymphoma. Ann Oncol 14: 277-281 [Abstract] [Full Text]  
• Jessup, M. (2003). The less familiar face of heart failure. J Am Coll Cardiol 41: 224-226 [Full Text]  
• Okura, Y., Dec, G. W., Hare, J. M., Kodama, M., Berry, G. J., Tazelaar, H. D., Bailey, K. R., Cooper, L. T. (2003). A clinical and histopathologic comparison of cardiac sarcoidosis and idiopathic giant cell myocarditis. J Am Coll Cardiol 41: 322-329 [Abstract] [Full Text]  
• Lewis, W. (2003). Defective mitochondrial DNA replication and NRTIs: pathophysiological implications in AIDS cardiomyopathy. Am. J. Physiol. Heart Circ. Physiol. 284: H1-H9 [Full Text]  
• Laissy, J.-P., Messin, B., Varenne, O., Iung, B., Karila-Cohen, D., Schouman-Claeys, E., Steg, P. G. (2002). MRI of Acute Myocarditis: A Comprehensive Approach Based on Various Imaging Sequences. Chest 122: 1638-1648 [Abstract] [Full Text]  
• Sato, M., Toyozaki, T., Odaka, K., Uehara, T., Arano, Y., Hasegawa, H., Yoshida, K., Imanaka-Yoshida, K., Yoshida, T., Hiroe, M., Tadokoro, H., Irie, T., Tanada, S., Komuro, I. (2002). Detection of Experimental Autoimmune Myocarditis in Rats by 111In Monoclonal Antibody Specific for Tenascin-C. Circulation 106: 1397-1402 [Abstract] [Full Text]  
• Suter, T. M., Meier, B. (2002). Detection of anthracycline-induced cardiotoxicity: is there light at the end of the tunnel?. Ann Oncol 13: 647-649 [Full Text]  
• Anderson, L.J., Holden, S., Davis, B., Prescott, E., Charrier, C.C., Bunce, N.H., Firmin, D.N., Wonke, B., Porter, J., Walker, J.M., Pennell, D.J. (2001). Cardiovascular T2-star (T2*) magnetic resonance for the early diagnosis of myocardial iron overload. Eur Heart J 22: 2171-2179 [Abstract]  
• Mehta, N. J., Mehta, R. N., Khan, I. A. (2001). Peripartum Cardiomyopathy: Clinical and Therapeutic Aspects. ANGIOLOGY 52: 759-762 [Abstract]  
• Elkayam, U., Tummala, P. P., Rao, K., Akhter, M. W., Karaalp, I. S., Wani, O. R., Hameed, A., Gviazda, I., Shotan, A. (2001). Maternal and Fetal Outcomes of Subsequent Pregnancies in Women with Peripartum Cardiomyopathy. NEJM 344: 1567-1571 [Abstract] [Full Text]  
• Reimold, S. C., Rutherford, J. D. (2001). Peripartum Cardiomyopathy. NEJM 344: 1629-1630 [Full Text]  
• Hare, J.M., Baughman, K.L. (2001). Fulminant and acute lymphocytic myocarditis: the prognostic value of clinicopathological classification. Eur Heart J 22: 269-270  
• MARSHALL, D., SACK, M. N (2000). Apoptosis: a pivotal event or an epiphenomenon in the pathophysiology of heart failure?. Heart 84: 355-356 [Full Text]  
• (2000). Cause of Cardiomyopathy Associated with Survival. Journal Watch Cardiology 2000: 6-6 [Full Text]  
• Givertz, M. M. (2000). Underlying Causes and Survival in Patients with Heart Failure. NEJM 342: 1120-1122 [Full Text]  
• Luscher, T. F (2000). Diagnosis of CHF -- often a trap In Itself. Journal of Renin-Angiotensin-Aldosterone System 1: 7-11 [Abstract]  
• Cappola, T. P., Felker, G. M., Kao, W.H. L., Hare, J. M., Baughman, K. L., Kasper, E. K. (2002). Pulmonary Hypertension and Risk of Death in Cardiomyopathy: Patients With Myocarditis Are at Higher Risk. Circulation 105: 1663-1668 [Abstract] [Full Text]