Alla et al developed an algorithm for classifying patients with dilated cardiomyopathy. This can help identify patients who may benefit from more aggressive management. The authors are the EPICAL (Epidemiologie de l'Insuffisance Cardiaque Avancee en Lorraine) Investigators from Nancy, France.
Patient selection - Severe congestive heart failure with one or more of the following:
(1) hospitalization with Class III or IV dyspnea, edema or hypertension
(2) ejection fraction <= 30%
(3) cardiothoracic index >= 60%
Exclusion: ischemic, valvular, congenital, chemotherapy, thoracic radiation, thyroid disease
Not excluded: hypertensive, alcoholic
Parameters:
(1) age of the patient
(2) comorbidity
(3) known cardiopathy
(4) functional status
(5) heart rate
(6) serum creatinine
(7) serum sodium
|
Parameter |
Findings |
Screen |
Points |
|
age of the patient |
<= 70 years of age |
0 |
0 |
|
|
> 70 years of age |
1 |
5 |
|
comorbidity |
no significant |
0 |
0 |
|
|
one or more significant |
1 |
4 |
|
cardiopathy |
no known cardiopathy |
0 |
0 |
|
|
known cardiopathy |
1 |
7 |
|
functional status |
non-dependent |
0 |
0 |
|
|
dependent |
1 |
7 |
|
heart rate |
<= 100 beats per minute |
0 |
0 |
|
|
> 100 beats per minute |
1 |
8 |
|
serum creatinine |
<= 180 µmol/L |
0 |
0 |
|
|
> 180 µmol/L |
1 |
6 |
|
serum sodium |
>= 138 mmol/L |
0 |
0 |
|
|
< 138 mmol/L |
1 |
4 |
where:
• Dependency indicates that the patient is assisted by relatives or lives in an institution.
• Known cardiopathy indicates duration >= 3 months. No known cardiopathy indicates that the cardiopathy is diagnosed during decompensation, with the time elapsed since first symptom of the underlying cardiopathy < 3 months.
• Serious comorbidities include cancer, cirrhosis, COPD, stroke or peripheral artery disease.
screening score =
= SUM(screening points for all 7 items)
total score =
= SUM(formal points for all 7 parameters)
Interpretation:
• minimum number of screening points: 0
• maximum number of screening points: 7
• maximum number of formal points: 41
|
Screening Score |
Formal Score |
Class |
Survival (Probability of 1 Year Survival) |
|
0 to 2 |
NA |
I |
high (> 75%) |
|
3 or 4 |
0 to 14 |
I |
high (> 75%) |
|
3 or 4 |
15 to 19 |
II |
intermediate (25-75%) |
|
3 or 4 |
20 to 41 |
III |
low (< 25%) |
|
5 to 7 |
NA |
III |
low (< 25%) |
Purpose: To evaluate a patient with a severe dilated cardiomyopathy using the algorithm of Alla and the EPICAL investigators.
Specialty: Cardiology
Objective: severity, prognosis, stage, failure handling and therapy escalation
ICD-10: I09.0, I51.4,
