Dilated cardiomyopathy. An echocardiographic follow-up of 50 patients

To evaluate the significance of left ventricular (LV) hypertrophy in dilated cardiomyopathy (DCM), 50 patients seen between 1976 and 1983 were studied echocardiographically. Patients were classified into 4 groups according to the degree of LV dilatation and LV hypertrophy. Group I consisted of 17 patients who had mild to moderate LV dilatation without LV hypertrophy (LV end-systolic dimension: Ds less than 60 mm, LV wall thickness at end-systole: WTs less than 15 mm). Group II consisted of 12 patients who had mild to moderate LV dilatation with LV hypertrophy (Ds less than 60 mm, WTs greater than or equal to 15 mm). Group III consisted of 8 patients who had marked LV dilatation with LV hypertrophy (Ds greater than or equal to 60 mm, WTs greater than or equal to 15 mm). Group IV consisted of 13 patients who had marked LV dilatation without LV hypertrophy (Ds greater than or equal to 60 mm, WTs less than 15 mm). Twenty patients had LV hypertrophy and 30 patients were without LV hypertrophy at the beginning of this study. New York Heart Association functional classes, cardiothoracic ratio and ECG findings during the first study did not show statistically significant difference among 4 groups. During a follow-up period averaging 2.7 years, 8 patients died of congestive heart failure (CHF), including 5 of Group IV patients and 3 of Group I patients who had progressive LV dilatation. Three patients without signs of CHF expired suddenly; they were in Groups I, II and III during the initial study. Ambulatory ECG studies showed complex ventricular arrhythmias in all 32 patients studied. In conclusion, LV wall hypertrophy in DCM may be an important factor to predict their prognosis regarding CHF death. Sudden and unexpected death could occur in any patient with DCM and intensive antiarrhythmic therapy is important.