Prognosis in dilated cardiomyopathy

In general, the prognosis for dilated cardiomyopathy is pessimistic: up to 70% of patients die within 5 years; approximately 50% of deaths are sudden and are due to malignant arrhythmia or embolism. The prognosis is better if the ventricular wall thickness is preserved due to compensatory hypertrophy, and worse if the walls are thinned, leading to ventricular dilation.

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 underlying cause of dilated cardiomyopathy is ischemic heart disease,
• Echocardiographic parameters that worsen the prognosis: left ventricular ejection fraction <35%, restrictive type of diastolic filling of the left ventricle, thinning of the heart walls, significant dilation of the heart chambers.
• Cardiac index <3.0 L/m2 ^of body surface area and left ventricular end-diastolic pressure >20 mmHg are considered risk 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 patient survival, but are also used to assess the course of the disease during patient management.
• Electrocardiographic examination allows to determine the presence of intraventricular conduction delays, ventricular arrhythmias (eg, ventricular extrasystoles) and paroxysmal ventricular tachycardias. The influence of rhythm and conduction disturbances on the prognosis of the disease remains a subject of discussion.
• The presence of sinus tachycardia and low systolic blood pressure worsens the prognosis.
• Changes in blood biochemical parameters (hyponatremia and increased levels of catecholamines, TNF, atrial natriuretic factor, ADH and serum creatinine) also worsen the prognosis of the disease.

However, individual predictors of poor prognosis among patients with idiopathic dilated cardiomyopathy are identified.

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Predictors of poor prognosis in idiopathic dilated cardiomyopathy

Biochemical features.

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

Clinical features.

• History of fainting.
• Male gender.
• Old age.
• CHF functional class IV.
• Persistent III tone, gallop rhythm.
• Symptoms of right ventricular heart failure.
• ECG features.
• Atrial fibrillation.
• AV block I-II degree.
• Left bundle branch block.
• Ventricular tachycardia.

Features of load tests.

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

Hemodynamic features.

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

Features of ventricular contrast.

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

Five-year survival after a confirmed diagnosis of dilated cardiomyopathy is less than 50%.