[Prognosis of dilated cardiomyopathy: an integrated study using a prognostic index]

A ten year follow-up study of 111 patients with dilated cardiomyopathy (DCM) was conducted. The five year survival rate after onset of subjective symptoms was 53%; the ten year survival rate, 22%. To evaluate the prognosis of DCM, the cardiothoracic ratio (CTR), ECG, hemodynamics, and histopathological contractility failure index (HCFI) which we constructed via a right ventricular endomyocardial biopsy, were compared. Patients having malignant arrhythmias with mildly impaired cardiac status, mild cardiomegaly and low HCFI were more prone to sudden death. In patients with progressively deteriorating cardiac status, refractory cardiomegaly, supraventricular arrhythmias, left axis deviation, prolongation of QRS interval, low voltage and high HCFI, the cause of death was more likely refractory heart failure. A prognostic index of DCM was then constructed through cardiac status, CTR, ECG, hemodynamics and HCFI. The mortality rate of the group with a prognostic index of seven points or below was 5.0%; the group with eight points or above was 82.1%. The prognostic index of DCM was thus shown to be a useful prognostic indicator.