PROGNOSIS AND CLINICAL COURSE OF DILATATI VE CARDIOMYOPATHY

Dilative cardiomyopathy is a heterogeneous myocardial disease characte rized by a depressed contractile function and ventricular dilation. Th e exercise intolerance of patients with dilative cardiomyopathy is par tly explained by changes of metabolism and composition of skeletal mus cle, whereas the physical findings result from progressive heart failu re and cardiac remodeling. The clinical course of the disease is highl y variable and prognostic indicators of progressive heart failure or c ardiac arrhythmias are of little value in the assessment of cardiac ri sk in an individual patient. During recent years the mortality of pati ents with dilative cardiomyopathy was 5 - 15 %, which appears to be lo wer than previously reported. The differences in mortality today and i n previous years may be explained by a more precise and earlier diagno sis of the disease and possibly better treatment strategies. Patients with a severely depressed left ventricular function but a stable clini cal course, a good hemodynamic response to therapy, and an oxygen upta ke of > 12 ml/kg min can be followed without heart transplantation. It can be expected that the definition of the molecular causes of dilati ve cardiomyopathy will lead to a better classification of the patients and the development of more efficient treatment strategies.