Prognostic value of serial cardiac assessment and familial screening in patients with dilated cardiomyopathy

Objectives: This prospective study was performed to analyse whether routine clinical follow-up investigations at 12±6 months add to risk stratification and improve survival rates in patients with a first diagnosis of dilated cardiomyopathy (DCM). Methods: Four hundred and eighty consecutive patients (mean age 53.4±12.3 years, 369 males, mean NYHA class 2.4±0.8) with invasively confirmed DCM were included and followed for 3.9±3.5 years. Patients were requested to adhere to a follow up investigation within 6–18 months either at the referring physicians or at our out patient department. Two hundred and eighty-one of the 480 patients presented for follow up which consisted of a detailed evaluation of symptoms, standardized physical examination, 12-lead-electrocardiogram recording and echocardiography. Seventeen patients were lost for follow up, 182 did not seek specialized medical follow up. Patients outcome was assessed by structured telephone interviews. Results: Independent predictors of death or transplantation at initial diagnosis were LV–ejection fraction <30% (P=0.0001, risk ratio 2.25), LV–end diastolic pressure &ges;15 mmHg (P=0.002, risk ratio 2.0), age &ges;54 years, (P=0.04, risk ratio 1.55), and presence of left bundle branch block (P=0.046, risk ratio 1.53). On follow up investigations only deterioration of clinical status by at least one NYHA-class (P=0.001, risk ratio 2.6) and new onset or worsening of mitral regurgitation (P=0.02, risk ratio 1.8), remained independent prognostic factors for cardiac death. Patients who presented for routine follow up revealed significant better 5-year survival rates (n=281, 70%) than those who did not (n=153, 55%, P=0.005). Conclusions: Routine clinical follow up investigations within 6–18 months after first diagnosis of DCM adds to risk stratification and improves survival rates. [Copyright &y& Elsevier]