Outcome of patients with dilated cardiomyopathy in a contemporary Swiss population

OBJECTIVE: Outcome of dilated cardiomyopathy (DCM) has markedly improved due to ACE-inhibitors, beta-blockers and implantable defibrillators over the last decades. Aims were both the determination of current mortality rates and the improvement of left ventricular function over time with regard to different baseline factors. METHODS AND RESULTS: The coronary angiography registry was screened between 2001 and 2003 for patients with DCM. Those still alive in 2005 (observation period 38 +/- 13 months) received a questionnaire about symptoms and drug therapy. Follow-up echocardiographies were obtained. Death was categorised as either sudden, cardiac or non-cardiac. "Full recovery" was defined as normal ejection fraction (EF). 128 patients, age 59 +/- 10 years, were identified. EF was 30 +/- 11%; 31% were in NYHA class I, 40% in II and 20% in III. 19 patients (16%) died, 5 sudden, 5 with heart failure, 9 due to non-cardiac causes. Annual mortality rate was 5%, cardiac alone 2.5%. All 5 patients who died suddenly had initially an EF of > 30%. Mean EF had improved to 41%, in 18 patients it was normal. Neither NYHA class nor therapy were predictors for "recovery", poor EF showed a trend to less "recovery" (28 +/- 11% vs. 33 +/- 14%, P > 0.06). There were no predictors in patients whose EF rose from below 25% to above 35% as compared to those in whom it was stable below 35%. CONCLUSIONS: Under optimal medical therapy, symptoms and EF improved in DCM patients. However, annual cardiac mortality was still 2.5%, but unfortunately no baseline predictors for either death or "recovery" were identified.