Long-Term Outcome and Prognostic Factors in Dilated Cardiomyopathy

Abstract

To investigate long-term follow-up and identify prognostic factors in patients with dilated cardiomyopathy (DCM) the authors investigated 167 consecutive patients on an outpatient basis. All patients underwent left- and right-heart catheterization; follow-up comprised clinical and echocardiographic investigations.

Results: After a mean follow-up period of ninety-three ± thirty-six months 82 patients (49%; 71 men, 11 women, mean age fifty-five ± eleven years) were alive. 29 of them (27 men, 2 women, mean age fifty-two ± nine) showed normal left ventricular ejection fraction (LVEF) after a mean follow-up period of one hundred four ± forty months. The remaining 53 patients (44 men, 9 women, mean age fifty-six ± eleven) revealed LVEF similar to that of the first examination. Eighty-five patients died (51%; 73 men, 12 women). Causes of death were the following: progressive heart failure, 24; sudden death, 23; stroke, 3; pulmonary embolism, 2; noncardiac death, 4; unknown causes, 29. The median period from the onset of first symptoms until definite diagnosis was two months in patients with stable conditions, three months in those with normalization of LVEF and twenty-four months in those who died, respectively (P < 0.01). At the time of diagnosis, patients with stable outcome had a mean LVEF (LVEF 1) of 37%, those who returned to normal had 40% (ns). Patients who died had a mean LVEF 1 of 32% and therefore differed significantly from both groups of survivors (P < 0.001). Left ventricular enddiastolic pressure (LVEDP) at the time of diagnosis was highest in patients who died (22 mmHg) and therefore differed significantly from both groups of survivors (normalization: 16 mmHg, stable patients: 18 mmHg, P < 0.001).

Conclusions: According to their results, time until diagnosis, LVEF, and LVEDP are prognostic indicators. No difference was noted between the groups concerning etiology, medical treatment, or functional classification according to the New York Heart Association.

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References

Fuster V. , Gersh BJ , Giuliani ER , et al: The natural history of idiopathic dilated cardiomyopathy. Am J Cardil 47:525-531, 1981.

Brandenburg RO , Chazov E. , Cherian G. , et al: Report of the WHO/ISFC task force on definition and classification of cardiomyopathies. Lancet 64:437A-438A, 1981.

Packer M. , Gottlieb SS , Blum, MA : Immediate and long-term pathophysiologic mechanisms underlying the genesis of sudden cardiac death in patients with congestive heart failure. Am J Med 82:4-10, 1987.

Manolio TA , Baughman KL , Rodeheffer R. , et al: Prevalence and etiology of idiopathic dilated cardiomyopathy (summary of a National Heart, Lung and Blood Institute Workshop). Am J Cardiol 69:1458-1466, 1992.

Delius W. , Sebning H. , Weghmann N. , et al: Clinical features and course of congestive cardiomyopathy of unknown aetiology. DCW 17:635-6641, 1976.

De Maria R. , Gavazzi A. , Caroli A. , et al: Ventricular arrhythmias in dilated cardiomyopathy as an independent prognostic hallmark. Am J Caridol 69:1451-1457, 1992.

Kuhn H. , Becker R. , Fischer J. , et al: Studies on the etiology, the clinical course and the prognosis of patients with dilated cardiomyopathy (DCM). Z Kardiol 71:497-508, 1982.

Unverferth DV , Magorien RD , Moeschberger ML , et al: Factors influencing the one-year mortality of dilated cardiomyopathy. Am J Cardiol 54:147-152, 1984.

Weininger F. , Regitz V. , Fleck E. : Prognostische Aussagen bei dilatativer Kardiomyopathie . Intensivmed 27:12-17, 1990.

10.

Schaper J. , Froede TA , Hein ST , et al: Impairment of the myocardial ultrastructure and changes of the cytoskeleton in dilated cardiomyopathy. Circulation 83:504-514, 1991.

11.

Dusleag J. , Klein W. , Eber B. , et al: Das Konzept einer "stummen" Herzinsuffizienz. Z Kardiol 80 (suppl 8):117-119, 1991.