The effect of recent advances in pharmacologic management on the prognosis of dilated cardiomyopathy.
To determine the effect of recent advances in medical management on the survival of patients with dilated cardiomyopathy (DCM), 103 patients with DCM were studied. The subjects were divided into 3 groups based upon the time of initial medical treatment at our institute: Group I, between 1976 and 1981, 20 patients; Group II, between 1982 and 1985, 27 patients; and Group III, between 1986 and 1991, 56 patients. The clinical, Holter electrocardiographic and echocardiographic findings, the pharmacologic treatments used, and the clinical outcomes for the 3 groups of patients were compared. During the follow-up period, which averaged 27 months, 31 deaths related to cardiac disease occurred. The 4 year survival rate was 76% in Group III, 49% in Group II and 35% in Group I; the difference in survival rate between Groups I and III was significant (p < 0.01). At the initial evaluation, no differences were found among the 3 groups in the incidences of advanced heart failure (NYHA functional class III or IV), atrial fibrillation or complex ventricular arrhythmias. Neither diastolic blood pressure nor heart rate differed among the 3 groups, but Group III patients were older and had significantly higher systolic blood pressures than Group I patients (p < 0.05, for both comparisons). There were no differences among the 3 groups in % fractional shortening, left ventricular end-systolic wall stress or left ventricular wall thickness, but left ventricular dimensions were significantly smaller in Group III than in Group I (p < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)
Yokota
Y
Y
First Department of Internal Medicine, Kobe University School of Medicine, Japan.
Tsumura
Y
Y
Takarada
A
A
Kawai
H
H
Yokoyama
M
M
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000328:Adult; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D000925:Anticoagulants / Q000627:therapeutic use; D002311:Cardiomyopathy, Dilated / Q000188:drug therapy* / Q000401:mortality; D004071:Digitalis Glycosides / Q000627:therapeutic use; D004232:Diuretics / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D015996:Survival Rate; D014665:Vasodilator Agents / Q000627:therapeutic use
D000319:Adrenergic beta-Antagonists; D000889:Anti-Arrhythmia Agents; D000925:Anticoagulants; D004071:Digitalis Glycosides; D004232:Diuretics; D014665:Vasodilator Agents