SYNCOPE IN DILATED CARDIOMYOPATHY IS A PREDICTOR OF SUDDEN CARDIAC DEATH

Fifty percent of patients with dilated cardiomyopathy die within 5 yea rs of diagnosis. Syncope is known to be a predictor of poor outcome in patients with advanced heart failure. To assess the risk of patients with dilated cardiomyopathy with a history of syncope during standard medical treatment we compared this group to similar patients without s yncope. Twenty-three patients with angiographically proven dilated car diomyopathy and syncope were followed prospectively and compared to 20 1 patients without history of syncope. All patients showed a left-vent ricular ejection fraction of less than 45%. Both groups did not differ in left-ventricular ejection fraction at baseline (30 +/- 7% in the s yncope group, 30 +/- 8% in the no syncope group) or during follow-up ( 40 +/- 13% in the syncope group, 41 +/- 13% in the no syncope group). Mean follow-up was 2.6 years in the syncope group and 2.4 years in the no syncope group, At baseline, syncope patients used more often amiod arone (p < 0.04), while there was no statistically significant differe nce between the two groups regarding the intake of digitalis, diuretic s and angiotensin-converting enzyme inhibitors, Twenty-six percent of patients in the syncope group and 20% in the no syncope group died dur ing follow-up (non significant). The striking difference, however, was the type of death: 5 out of 6 patients in the syncope group died sudd enly compared to 13 of 41 patients in the no syncope group (p < 0.025) . Patients with dilated cardiomyopathy and a history of syncope are at high risk of sudden death.