ackground : Dilated cardiomyopathy is a progressive disease of uncertain origin and the
prediction of the clinical course in an individual patient remained to be defined.
Method : In order to understand the clinical manifestation, laboratory findings, clinical
courses and prognostic factors of Korean patients with dilated cardiomyopathy, the medical
recordings of 171 patients with dilated cardiomyopathy (103 primary, 68 secondary) were
reviewed.
Results :
1) Studied subjects were 110 male and 61 female patients and aged of 56.3±13.6 years.
2) NYHA functional class was 3.2±0.7 and duration of symptoms were shorter than one
month in 38.6%, shorter than 6 month in 61.4%, and longer than one year in 26.9%.
3) Most common complaints were exertional dyspnea (86.5%), orthopnea (28.7%), cough
(21.1%), palpitation (18.7%), chest discomfort (17.0%), and paroxysmal nocturnal dyspnea
(9.4%).
4) Physical findings were palpable liver, rales in lungs, pitting edema, gallop rhythm,
increased jugular venous pressure (JVP), apical systolic murmur, etc.
5) Dysarrhythmias including atrial fibrillation (28.7%), premature ventricular contraction
(17.0%), complete left bundle branch block (13.5%), paroxysmal supraventricular tachycardia
(2.9%), and ventricular tachycardia (1.2%) were observed. Abnormal EKG findigs other than
dysarrhythmias were left ventricular hypertrophy, left atrial hypertrophy, myocardial ischemia,
non specific ST-T change, and right atrial hypertrophy, etc.
6) The M-mode echocardiogram at the first examination revealed that the left ventricular
end-diastolic and end-systolic dimensions were 6.9±0.9 cm, 5.9±.1 cm, ejection fraction 36.7
±2.8%, left atrial dimension 4.8±.8 cm, mitral E point septal separation (EPSS) 25±9mm,
total and rapid emptying fraction of left atrium 31.4±12.7%, 19.8±10.1%.
7) Associated diseases of factors which may contribute to damage myocardium in
secondary form of dilated cardiomyopathy patients were hypertersion, heavy alcohol abuse,
diabetes mellitus, chronic obstructive pulmonary disease, chronic liver disease, acute viral
hepatitis, peripartum, hyperthyroidism, and systemic lupus erythematosus, etc.
8) Most patients were treated by two or more combined drug regimens and clinical
responses to the medical treatment during the follow-up period (mean 10.8 9.4 months) were
improved in 63.3%, unchanged in 19.6%, deteriorated in 4.4%, and dead in 12.7%.
9) Causes of death were sudden in 12 patients, congestive heart failure 5, cerebrovascular
accident 2, and acute renal failure after angiography one. There were no significant
differences between primary and secondary form of dilated cardiomyopathy patients groups,
statistically.
10) Multiple logistic regression analysis revealed that the important prognostic factors were
intraventricular conduction disturbance, atrial hypertrophy in EKG, NYHA functional class
more than III, and elevated JVP.
Conclusion : Clinical manifestations of dilated cardiomyopathy are not much different from
those reported in western countries. The majority of the patients can be benefited with
currently available medical treatment at least in a short term period. A prospective studies
are necessary to indentify the risk factors and long-term natural history in conjunction with
periordic follow-up endomyocardial biopsies after treatment with various suggested regimens
to elucidate their long-term benefit.
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