[Prognosis of primary non-obstructive cardiomyopathies]

The prognosis of congestive cardiomyopathy was studied in 132 consecutive patients (110 male, 22 female, average age 45 +/- 11 years) in whom a thorough clinical evaluation had excluded a secondary cause. The patients presented with left ventricular failure, a history of systemic embolism, syncope or radiological cardiomegaly. Right (100 p. 100) and left (81 p. 100) heart catheterisation was performed and left ventricular endiastolic volumes (202 +/- 77 ml/m2) and ejection fractions (31 +/- 12 p. 100) calculated from angiography in the 30 degrees right anterior oblique projection. Regional abnormalities of contraction were observed in 32 patients. The average follow up period was 40,4 +/- 23,8 months. At the end of the study 48 patients (37 p. 100) had died and 2 had been lost to follow up. Survival rates were calculated by actuarial methods. Age, sex, the period they had been symptomatic, alcoholic intoxication and the degree of cardiac dilatation were not significant prognostic factors. Patients in Class IV NYHA had the worst prognosis: 63 p. 100 2 year mortality. Atrioventricular conduction defects were observed in 56 patients and were associated with a significantly increased mortality rate (43 p. 100 compared with 23 p. 100, p < 0.001). Atrial fibrillation (32 patients) was a better prognostic factor than the persistence of sinus rhythm; 2 year mortality 11,1 p. 100 compared to 37,6 p. 100 (p < 0.001). Increased left ventricular end diastolic pressures greater than 20 mmHg were related with a mortality of 51,5 p. 100. Also, the patients with a ejection fraction of 30 p. 100 and a 2 year mortality rate of 44 p. 100 compared to 17,5 p. 100 when the ejection fraction was greater than 30 p. 100 (p < 0,001). In conclusion : 1. Regional abnormalities of left ventricular contraction are not rare in primary cardiomyopathy. 2. The prognosis is directly related to the degree of cardiac failure and the extent of left ventricular dysfunction.