Hagege A, Desnos M, Fernandez F, Cristofini P, Guenot O, Bourmayan C, Marcantoni J P, Guerot C
Service de cardiologie, hôpital Boucicaut, Paris.
Arch Mal Coeur Vaiss. 1988 Dec;81(12):1473-9.
One hundred and sixteen patients (mean age 46 years) with dilated cardiomyopathy documented by haemodynamic investigations and angiography with normal coronary arteriography were followed up for a mean period of 29 +/- 19 months. During that period, 36% of the patients died after a follow-up of 30 +/- 20 months. The actuarial death rates were 15% at 2 years, 45% at 6 years and 60% at 10 years. The main factors predictive of survival at 10 years were the clinical and haemodynamic markers of left heart failure. The death rate was multiplied by 1.6 in patients in stages III or IV of the NYHA classification (83% vs 51%, p less than 0.01), by 2.6 in patients with left ventricular end-diastolic pressure above 15 mmHg (73% vs 29%, p less than 0.01), by 2.2 when the indexed end-diastolic volume rose above 200 ml/m2 (75% vs 35%, p less than 0.01), by 2.2 when the left ventricular ejection fraction was below 40% (75% vs 35%, p less than 0.05) and by 2.6 when angiographic mitral valve regurgitation was present (75% vs 34%, p less than 0.01). The death rate at 9 years was 2.3 times higher in patients with left bundle branch block (72% vs 36%, p less than 0.05). A cardiothoracic index over 0.60 proved to be of poor prognosis at one year (death rate: 19%). While alcoholism played no part in the prognosis, the death rate in smokers was consistently higher than in non smokers (56% vs 32% at 6 years, p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)
116例经血流动力学检查及冠状动脉造影显示冠状动脉正常的扩张型心肌病患者（平均年龄46岁），平均随访29±19个月。在此期间，36%的患者在随访30±20个月后死亡。2年时的精算死亡率为15%，6年时为45%，10年时为60%。预测10年生存率的主要因素是左心衰竭的临床和血流动力学指标。纽约心脏协会（NYHA）心功能分级Ⅲ或Ⅳ级的患者死亡率增加1.6倍（83%对51%，p<0.01），左心室舒张末期压力高于15 mmHg的患者死亡率增加2.6倍（73%对29%，p<0.01），当指数化舒张末期容积超过200 ml/m²时死亡率增加2.2倍（75%对35%，p<0.01），左心室射血分数低于40%时死亡率增加2.2倍（75%对35%，p<0.05），存在血管造影二尖瓣反流时死亡率增加2.6倍（75%对34%，p<0.01）。左束支传导阻滞患者9年时的死亡率高出2.3倍（72%对36%，p<0.05）。心胸指数超过0.60在1年时预后较差（死亡率：19%）。虽然酗酒对预后无影响，但吸烟者的死亡率始终高于非吸烟者（6年时56%对32%，p<0.05）。（摘要截选至250字）
