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Prognosis of idiopathic dilated cardiomyopathy
P J Keeling1, J H Goldman, A K Slade
1Department of Cardiological Sciences, St. George's Hospital, London, United Kingdom.
Insights
Dilated cardiomyopathy patients in this study showed a better prognosis than expected, with most remaining stable or improving. Established predictors of poor outcomes had limited value, suggesting advances in heart failure management and transplantation improve survival.
Area of Science:
- Cardiology
- Heart Failure Research
- Clinical Outcomes
Background:
- Previous studies indicated a poor prognosis for dilated cardiomyopathy in referral populations.
- This research investigates mortality and morbidity in a specific patient cohort presenting between 1989 and 1993.
Purpose of the Study:
- To evaluate the long-term mortality and morbidity outcomes for patients with dilated cardiomyopathy.
- To assess the predictive value of established prognostic factors in this patient group.
Main Methods:
- A consecutive series of 172 patients with dilated cardiomyopathy were studied.
- Data collected included New York Heart Association functional class, left ventricular dimensions, ejection fraction, VO2 max, and serum sodium levels.
- Follow-up averaged 26 months, tracking mortality, heart failure progression, and cardiac transplantation.
Main Results:
- The majority of patients (59%) remained stable or showed improvement.
- Established prognostic factors (e.g., ejection fraction, left ventricular end-diastolic dimension) demonstrated low predictive value for adverse events.
- One- and two-year probabilities of death or transplantation were 16% and 21%, respectively.
Conclusions:
- Despite referral bias, findings suggest a more favorable prognosis for dilated cardiomyopathy than previously reported.
- Advances in heart failure management, earlier diagnosis, and cardiac transplantation likely contribute to improved survival rates.
- Traditional prognostic markers may be less reliable in contemporary patient cohorts.
Abstract:
Previous reports in referral populations have emphasized the poor prognosis of dilated cardiomyopathy. This study evaluated mortality and morbidity in patients presenting at a referral center between 1989 and 1993. One hundred seventy-two consecutive patients were studied. At presentation, 82 were in New York Heart Association functional class III/IV. Mean (+/- SD) left ventricular end-diastolic dimension was 69 +/- 11 mm, ejection fraction was 25 +/- 10%, VO2 max was 21 +/- 9 mL/min/kg, and sodium was 136 +/- 9 mM. Treatments included vasodilators (n = 157, 92%), anticoagulation (n = 50, 29%), amiodarone (n = 52, 30%), and cardiac defibrillator (n = 5, 3%). During the follow-up period (mean, 26 +/- 29 months), 16 patients died and 60 developed progressive heart failure; 46 (27%) required cardiac transplantation. The majority of the patients (102, 59%) were stable or improved. Established prognostic determinants (left ventricular end-diastolic dimension, ejection fraction, sodium, and arrhythmia) were of low predictive value for the development of progressive heart failure or sudden death. The 1- and 2-year probabilities of death or transplantation was 16 and 21%, respectively (death only 6 and 7%, respectively). These observations are subject to referral bias, but suggest that the majority of patients can remain stable. Any improvement in survival compared to earlier experience can be due to earlier diagnosis, availability of transplantation, and new heart failure management strategies.