LONG-TERM OUTCOME AND PROGNOSTIC FACTORS IN DILATED CARDIOMYOPATHY - PRELIMINARY-RESULTS

To investigate long-term follow-up and identify prognostic factors in patients with dilated cardiomyopathy (DCM) the authors investigated 16 7 consecutive patients on an outpatient basis. All patients underwent left- and right-heart catheterization; follow-up comprised clinical an d echocardiographic investigations. Results: After a mean follow-up pe riod of ninety-three +/- thirty-six months 82 patients (49%; 71 men, 1 1 women, mean age fifty-five +/- eleven years) were alive. 29 of them (27 men, 2 women, mean age fifty-two +/- nine) showed normal left vent ricular ejection fraction (LVEF) after a mean follow-up period of one hundred four +/- forty months. The remaining 53 patients (44 men, 9 wo men, mean age fifty-six +/- eleven) revealed LVEF similar to that of t he 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 sympt oms until definite diagnosis was two months in patients with stable co nditions, 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 3 7%, those who returned to normal had 40% (ns). Patients who died had a mean LVEF 1 of 32% and therefore differed significantly from both gro ups of survivors (P < 0.001). Left ventricular end-diastolic pressure (LVEDP) at the time of diagnosis was highest in patients who died (22 mmHg) and therefore differed significantly from both groups of survivo rs (normalization: 16 mmHg, stable patients: 18 mmHg, P < 0.001). Conc lusions: According to their results, time until diagnosis, LVEF, and L VEDP are prognostic indicators. No difference was noted between the gr oups concerning etiology, medical treatment, or functional classificat ion according to the New York Heart Association.