Prediction of outcome in dilated cardiomyopathy.

R A Diaz, A Obasohan, C M Oakley

Department of Medicine (Clinical Cardiology), Royal Postgraduate Medical School, Hammersmith Hospital, London.

One hundred and sixty nine patients (mean age 39.1 years) with documented dilated cardiomyopathy were studied for a mean of 5.5 years One hundred and four patients died during this period. The average (SD) interval from the onset of symptoms to death was 4.1 (3.7) years. One year and five year mortality rates were 27.8% and 57.4% respectively. Most of the deaths occurred within two years of diagnosis. The only difference between survivors and those who died was in the severity of left ventricular dysfunction at the time of referral. Significant differences between survivors and non-survivors were found for left ventricular end diastolic pressure (17.3 versus 23.4 mm Hg), left ventricular end systolic volume (87.4 versus 128.9 ml/m2), left ventricular end diastolic volume (130.7 versus 173.2 ml/m2), and ejection fraction (32.8 versus 25.4%). The duration of previous symptoms, preceding virus infection, positive family history, recent pregnancy, or heavy alcohol intake did not seem to influence prognosis. Nor did treatment, which was similar in both groups with a quarter of the patients receiving vasodilators. Patients with dilated cardiomyopathy have a high mortality irrespective of treatment. The only identifiable prognostic indicator was the severity of left ventricular impairment at referral.

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