PROGNOSTIC VALUE OF CHANGES IN LEFT-VENTRICULAR DIASTOLIC FUNCTION INPATIENTS WITH IDIOPATHIC DILATED CARDIOMYOPATHY

A total of 39 patients with idiopathic dilated cardiomyopathy (IDC) an d sinus rhythm were examined for correlations between clinical course, systolic/diastolic cardiac function, and clinical status according to NYHA class (I-IV). Patients were divided in two groups: group 1 inclu ded survivors (n = 28, 49 +/- 11 years) and group 2 the nonsurvivors ( n = 7) and transplanted patients (n = 4 transplanted; 48 +/- 10 years) . Both groups were examined several times, and data at baseline were c ompared with those of the last examination. The follow-up period was a bout 3 years (group 1: 41 +/- 22 months, group 2: 24 +/- 13). Baseline conditions were defined at the time when the diagnosis of IDC was est ablished. Diastolic cardiac function was evaluated by Doppler echocard iography parameters of early (V-E) and late diastolic peak velocity (V -A), the ratio of V-E/V-A and early deceleration time (EDT). Data for clinical symptoms (NYHA group 1: 2.5 +/- 0.9 vs. group 2: 2.7 +/- 1.3, NS), systolic [fractional shortening (FS) group 1: 0.17 +/- 0.06 vs. group 2: 0.16 +/- 0.06, NS], and diastolic function (V-E V-A, V-E/V-A) showed no differences between the two groups. Only the EDT was signif icantly shorter in group 2 (group 1: 196 +/- 64 ms vs. group 2: 119 +/ - 43 ms, P < 0.001) when diagnosis was established. During the follow- up period there was an improvement in both groups concerning NYNA clas s (group 1 from 2.5 +/- 0.9 to 1.9 +/- 0.7, P < 0.005; group 2 from 2. 7 +/- 1.3 to 2.1 +/- 0.9, NS). There was a nonsignificant deterioratio n in systolic function in group 2 (FS, from 0.16 +/- 0.06 to 0.15 +/- 0.06, P = 0.07), which contrasted to an improvement in group 1 (from 0 .17 +/- 0.06 to 0.20 +/- 0.08, P = 0.06). V-E/V-A increased in group 2 (from 1.24 to 1.67 +/- 1.21, P = 0.09) essentially due to a significa ntly increased V-E (from 0.66 +/- 0.2 m/s to 0.85 +/- 0.27 m/s, P < 0. 05). EDT remained shorter in group 2 (group 1: 198 +/- 55 ms vs. 149 /- 84 ms, P < 0.05). In conclusion, values of V-E > 0.8 m/s, V-E/V-A > 1.6, and EDT < 150 ms during follow-up were predictors of poor progno sis in patients with IDC. Patients with a long EDT (> 150 ms) had a fa vorable prognosis for survival.