Ohkawa S, Inoue J, Sugiura M
J Cardiogr Suppl. 1986(9):35-47.
This is a report of a clinicopathologic study of seven cases with dilated cardiomyopathy (DCM) among 3,000 consecutive autopsied cases 60 years or more in age. In this study DCM in the aged was defined as 1) cases of refractory heart failure with marked cardiomegaly of unknown cause by clinical and pathologic examinations, excluding hypertensive heart disease, ischemic heart disease, and valvular heart disease, and 2) pathologic examinations showing cardiac weight more than 400 g, normal coronary arteries with less than 9/15 coronary stenotic index (CSI) and a globular shaped heart with marked dilatation of the left ventricle. The following results were obtained: Seven cases of DCM in the aged consisted of two men and five women with an average age of 69.7 years. The incidence was 0.23% (7/3,000 autopsies). The average age of this group was less than those with other heart diseases such as myocardial infarction or valvular disease in the aged.
The clinical course ranged from 3 to 22 years with a mean of 12 years. The symptoms of three of the seven cases persisted from the middle age. Electrocardiograms showed atrial fibrillation in five cases (71%), left bundle branch block in three (43%) and complete heart block in one (14%). The mean cardiothoracic ratio was 77.3%. Valvular regurgitation was detected in five cases including five with mitral regurgitation (MR) and three with tricuspid regurgitation (TR). All patients died of cardiac events. Pathologic findings: The heart weights ranged from 410 g to 600 g, with an average of 527 g, and a CSI from 1/15 to 8/15 with a mean of 4.4/15. Though five cases had valvular regurgitation, no primary change was observed in the corresponding valves. Therefore, the valvular regurgitation in these cases were attributed to secondary changes due to dilatation of the valve ring and/or associated decreased compliance of the ventricular wall. The circumferences of the atrioventricular valve rings were enlarged, but the semilunar valve rings were in normal range. Bilateral atrial and ventricular volumes calculated morphologically were larger [201 ml (normal 77 ml) and 83 ml (normal 29 ml), respectively]. Three cases had mural thrombi, two of whom developed pulmonary infarction. Histologically, there were three cases with the fibrosis dominant type, two with the hypertrophy dominant type, one with the degenerative type, and one of the mixed type, respectively.
这是一份对3000例60岁及以上连续尸检病例中7例扩张型心肌病（DCM）患者的临床病理研究报告。在本研究中，老年DCM的定义为：1）经临床和病理检查，原因不明的难治性心力衰竭伴明显心脏扩大，排除高血压性心脏病、缺血性心脏病和瓣膜性心脏病；2）病理检查显示心脏重量超过400g，冠状动脉正常，冠状动脉狭窄指数（CSI）小于9/15，心脏呈球形，左心室明显扩张。结果如下：7例老年DCM患者中，男性2例，女性5例，平均年龄69.7岁。发病率为0.23%（7/3000例尸检）。该组患者的平均年龄低于老年心肌梗死或瓣膜病等其他心脏病患者。
临床病程为3至22年，平均12年。7例患者中有3例从中年起症状持续存在。心电图显示5例（71%）房颤，3例（43%）左束支传导阻滞，1例（14%）完全性心脏传导阻滞。平均心胸比率为77.3%。5例检测到瓣膜反流，其中5例二尖瓣反流（MR），3例三尖瓣反流（TR）。所有患者均死于心脏事件。病理发现：心脏重量在410g至600g之间，平均为527g，CSI在1/15至8/15之间，平均为4.4/15。虽然5例有瓣膜反流，但相应瓣膜未观察到原发性改变。因此，这些病例中的瓣膜反流归因于瓣膜环扩张和/或相关心室壁顺应性降低引起的继发性改变。房室瓣膜环周长增大，但半月瓣环在正常范围内。形态学计算的双侧心房和心室容积较大[分别为201ml（正常77ml）和83ml（正常29ml）]。3例有壁血栓，其中2例发生肺梗死。组织学上，分别有3例为纤维化为主型，2例为肥大为主型，1例为退行性型，1例为混合型。
