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Dilated cardiomyopathy: long-term follow-up and predictors of survival
Y Juillière1, N Danchin, S Briançon
1Cardiologie B, CHU Nancy-Brabois, France.
Insights
Dilated cardiomyopathy survival is poor, with 50% mortality within 5 years. Prognostic factors include low ejection fraction, high end-diastolic pressure, and advanced heart failure symptoms.
Area of Science:
- Cardiology
- Internal Medicine
Background:
- Dilated cardiomyopathy (DCM) is a significant cause of heart failure.
- Long-term survival and prognostic factors in DCM require further elucidation.
Purpose of the Study:
- To determine long-term survival rates in patients with dilated cardiomyopathy.
- To identify prognostic factors associated with mortality in DCM.
Main Methods:
- Retrospective study of 111 patients with DCM diagnosed between 1970-1979.
- Inclusion criteria: normal coronary angiography, diffuse left ventricular hypokinesia, ejection fraction <50%.
- Follow-up ranged from 6-16 years, with data from medical records, practitioners, and patient questionnaires.
Main Results:
- Actuarial survival rates were 90% at 1 year, 50% at 5 years, and 33% at 10 years.
- 63% of patients died during follow-up (37% from heart failure, 19% from sudden death).
- Significant 10-year mortality predictors included: low ejection fraction (<30%), elevated left ventricular end-diastolic pressure (>10 mm Hg), high cardiothoracic ratio (>54%), severe dyspnea (NYHA class III/IV), and left ventricular hypertrophy.
Conclusions:
- Dilated cardiomyopathy is associated with poor long-term survival.
- Several clinical and echocardiographic parameters predict mortality in DCM patients.
- Excessive alcohol consumption was prevalent in 56% of the studied cohort.
Abstract:
To determine long-term survival and the prognostic factors of dilated cardiomyopathy, we retrospectively studied a consecutive series of 111 patients (95 men, 16 women, mean age: 45.5 +/- 8.1 years) undergoing cardiac catheterization and diagnostic coronary angiography from January 1970 to December 1979. The inclusion criteria were: normal coronary angiography, diffuse hypokinesia of the left ventricle and left ventricular ejection fraction less than 50%. Base-line clinical data were collected from the hospital records and follow-up data were obtained from the general practitioners and cardiologists. A questionnaire was sent to all living patients. The length of follow-up ranged from 6 to 16 years. Six patients (5%) were lost to follow-up. At the time of catheterization, a majority of the patients had dyspnea and were in New York Heart Association (NYHA) classes II (41%) and III (31%). Clinical history revealed an excessive alcohol consumption in 56% of the patients. During follow-up, 66 patients (63%) died (heart failure: 37%; sudden death: 19%; non-cardiac death: 15%; unknown cause: 27%). Actuarial survival was 90, 50, and 33% at 1, 5, and 10 years, respectively. Univariate analysis revealed that 10-year mortality was related to: left ventricular ejection fraction less than 30%; left ventricular end-diastolic pressure greater than 10 mm Hg; cardiothoracic ratio greater than 54%; episodes of heart failure; left ventricular end-diastolic volume greater than 200 ml/m2, dyspnea of NYHA class III or IV; absence of smoking; absence of moderate systemic hypertension; electrocardiographic evidence of left ventricular hypertrophy and mean systemic arterial pressure greater than 95 mm Hg.(ABSTRACT TRUNCATED AT 250 WORDS)