Department of Medicine and Geriatrics, Kochi Medical School, Oko-cho, Nankoku-shi, Kochi 783-8505, Japan.
J Cardiol. 2008 Oct;52(2):111-7. doi: 10.1016/j.jjcc.2008.06.001. Epub 2008 Jul 17.
Although dilated cardiomyopathy (DCM) had a poor prognosis in the past, recent studies have shown better survival. However, little is known about the improvement of prognosis in the elderly. This study sought to clarify the changes in prognosis in elderly patients with DCM over the past 20 years.
We studied 54 consecutive patients with DCM (38 men and 16 women, aged 65-83 years) who were diagnosed at over 65 years of age. The patients were divided into two groups (group A: 12 patients diagnosed before 1990; group B: 42 patients diagnosed after 1990) because after 1990, based on growing evidence from large-scale, randomized clinical studies, we intentionally increased the use of angiotensin-converting enzyme inhibitors (ACEI) and then beta-blockers at our hospital.
There were no significant differences in age, gender, NYHA functional class, and the prevalence of atrial fibrillation and ventricular tachycardia between the two groups. Left ventricular (LV) size assessed by echocardiography was larger (LV end-diastolic diameter, 67+/-5.9 versus 62+/-6.6 mm; p=0.039) and LV ejection fraction measured by left ventriculography was lower (ejection fraction, 24+/-9 versus 35+/-10%; p=0.004) in group A. ACEI/angiotensin II type 1 receptor blockers (ARB) (0% versus 88%) or beta-blockers (0% versus 52%) were more frequently used in group B. Antiarrhythmics (class Ia or Ib) (75% versus 14%) were less often used in group B. The 5- and 10-year event-free survival rates for cardiac death were 75.4% and 22.0% in group A versus 81.2% and 71.3% in group B (log-rank test, p=0.014).
The prognosis of DCM patients in the elderly has significantly improved over the past 20 years. The advances in the pharmacologic treatment and earlier diagnosis may have contributed to the better survival.
尽管扩张型心肌病（DCM）过去的预后较差，但最近的研究表明其生存率有所提高。然而，对于老年人预后改善的情况知之甚少。本研究旨在阐明过去 20 年中老年 DCM 患者预后的变化。
我们研究了 54 例连续的 DCM 患者（38 名男性和 16 名女性，年龄 65-83 岁），这些患者均在 65 岁以上被诊断。这些患者被分为两组（A 组：12 例患者于 1990 年前诊断；B 组：42 例患者于 1990 年后诊断），因为在 1990 年后，基于大规模随机临床试验的大量证据，我们在我院有意增加了血管紧张素转换酶抑制剂（ACEI）和β受体阻滞剂的使用。
两组患者的年龄、性别、纽约心脏协会（NYHA）功能分级、心房颤动和室性心动过速的发生率均无显著差异。超声心动图评估的左心室（LV）大小（LV 舒张末期直径，67±5.9 毫米 vs. 62±6.6 毫米；p=0.039）较大，左心室造影测量的 LV 射血分数（ejection fraction，24±9% vs. 35±10%；p=0.004）较低。B 组 ACEI/血管紧张素 II 型 1 型受体阻滞剂（ARB）（0% 比 88%）或β受体阻滞剂（0% 比 52%）的使用率较高。B 组抗心律失常药物（I 类或 Ib 类）（75% 比 14%）的使用率较低。A 组的 5 年和 10 年无心脏死亡事件生存率分别为 75.4%和 22.0%，B 组分别为 81.2%和 71.3%（对数秩检验，p=0.014）。
过去 20 年来，老年 DCM 患者的预后显著改善。药物治疗的进步和更早的诊断可能是生存率提高的原因。
