Prognosis for dilated cardiomyopathy

In general, the prognosis of dilated cardiomyopathy is pessimistic: up to 70% of patients die in the period up to 5 years; approximately 50% of deaths are sudden and result from malignant arrhythmia or embolism. The prognosis is better if, due to compensatory hypertrophy, the thickness of the ventricular wall is preserved, and worse, if the walls are thinned, which leads to the expansion of the ventricles.

Currently, prognostic factors have been established for the entire group of dilated cardiomyopathy.

• In elderly patients with poor cardiac function, the prognosis is worse, especially if the basis for the development of dilated cardiomyopathy is ischemic heart disease,
• Echocardiographic parameters worsening the prognosis: left ventricular ejection fraction <35%, restrictive type of diastolic filling of the left ventricle, thinning of the heart walls, significant expansion of the heart chambers.
• Cardiac index <3.0 l / m ^{2 of} the body surface and left ventricular end-diastolic pressure> 20 mmHg. Are among the threatening factors.
• The absence of heart rate variability according to Holter monitoring data may indicate an unfavorable outcome of the disease.
• Signs of cardiomegaly on chest radiographs with an increased cardiothoracic index (> 0.55) are not only a prognostic factor for survival of patients, but are also used to assess the course of the disease in the management of patients.
• Electrocardiography allows to determine the presence of delays in intraventricular conduction, ventricular arrhythmias (for example, ventricular extrasystoles) and paroxysmal ventricular tachycardias. The effect of rhythm disturbances and conduction on the prognosis of the disease remains the subject of discussion.
• The presence of sinus tachycardia and low systolic blood pressure worsens the prognosis.
• Changes in biochemical parameters of blood (hyponatremia and increased levels of catecholamines, TNF, atrial sodium urethic factor, ADH and serum creatinine) also worsen the prognosis of the disease.

However, separate predictors of poor prognosis among patients with idiopathic dilated cardiomyopathy.

[1], [2], [3], [4], [5], [6], [7], [8],

Predictors of poor prognosis for idiopathic dilated cardiomyopathy

Biochemical features.

• Increased levels of angiotensin II.
• Increase of the level of atrial sodium of uretic peptide.
• Increased level of epinephrine (adrenaline).
• Elevated levels of norepinephrine (norepinephrine).

Clinical features.

• Fainting in the anamnesis.
• Male.
• Elderly age.
• CHF IV functional class.
• The remaining III tone, the rhythm of the canter.
• Symptoms of right ventricular heart failure.
• ECG features. 
• Atrial fibrillation.
• AV blockade of I-II degree.
• Blockade of the left branch of the bundle of His.
• Ventricular tachycardia.

Features of stress tests.

• Peak oxygen consumption <12 ml / kg per minute.

Hemodynamic features.

• High cardiac index.
• High pressure in the right atrium.
• Low average blood pressure.
• Pulmonary artery wedge pressure> 20 mmHg

Features of contrasting of the ventricles.

• Reduced volume of filling of ventricles.
• Abnormal global contraction of ventricular walls.
• Reduced ejection fraction of the left ventricle.
• Dilation of the right ventricle.
• Spherical geometry of the left ventricle.

The five-year survival rate after the confirmed diagnosis of dilated cardiomyopathy is less than 50%.