Di Lenarda A, Secoli G, Perkan A, Gregori D, Lardieri G, Pinamonti B, Sinagra G, Zecchin M, Camerini F
Department of Cardiology, Ospedale Maggiore and University, Trieste, Italy.
Br Heart J. 1994 Dec;72(6 Suppl):S46-51. doi: 10.1136/hrt.72.6_suppl.s46.
To analyse the changes in mortality in dilated cardiomyopathy over the past 15 years and to identify the factors that might have influenced survival.
Follow up study of 235 patients (aged 16-70) systematically enrolled on a register from 1 January 1978 to 31 December 1992.
Hospital department of cardiology.
Three groups corresponding to three periods of 5 years: group 1 (diagnosis between 1 January 1978 and 31 December 1982) 26 patients; group 2 (diagnosis between 1 January 1983 and 31 December 1987) 65 patients; and group 3 (diagnosis between 1 January 1988 and 31 December 1992) 144 patients.
Death or heart transplantation.
Two and four year survival was 73.8% and 53.8% in group 1, 87.7% and 72.3% in group 2, and 90.3% and 82.9% in group 3 (P = 0.02). During the 15 years of the study period the number of cases increased progressively and the baseline clinical characteristics changed (that is, patients were younger and less severely affected), partly explaining the improvement in survival. None the less, the three mortality curves tended to diverge progressively and the improvement in survival in the different groups was still significant after stratification for the severity of the disease, suggesting that treatment had a sustained effect. A progressively higher proportion of patients were treated with angiotensin converting enzyme (ACE) inhibitors and more recently with beta blockers. In group 2, after stratification for the severity of heart failure, patients who were treated with ACE inhibitors showed a better survival than patients who were not. Furthermore, analysis of group 3 showed that beta blockers had a significant additive effect with conventional therapy both by intention to treat and actual treatment. Four year survival in patients with mild and moderate to severe heart failure treated with beta blockers, and usually digitalis and ACE inhibitors, was respectively 90% and 87.5%.
The improvement in the survival of patients with dilated cardiomyopathy over the past 15 years may be explained by earlier diagnosis, new treatments, and a change in the clinical characteristics of the patients at enrolment.
分析过去15年扩张型心肌病患者死亡率的变化，并确定可能影响生存的因素。
对1978年1月1日至1992年12月31日系统登记在册的235例患者（年龄16 - 70岁）进行随访研究。
医院心内科。
分为三组，对应三个5年时间段：第1组（1978年1月1日至1982年12月31日诊断）26例患者；第2组（1983年1月1日至1987年12月31日诊断）65例患者；第3组（1988年1月1日至1992年12月31日诊断）144例患者。
死亡或心脏移植。
第1组的2年和4年生存率分别为73.8%和53.8%，第2组为87.7%和72.3%，第3组为90.3%和82.9%（P = 0.02）。在15年的研究期间，病例数逐渐增加，基线临床特征发生变化（即患者更年轻且病情较轻），这部分解释了生存率的提高。尽管如此，三条死亡率曲线逐渐趋于分离，在按疾病严重程度分层后，不同组生存率的提高仍然显著，这表明治疗有持续效果。接受血管紧张素转换酶（ACE）抑制剂治疗的患者比例逐渐增加，最近使用β受体阻滞剂治疗的患者也增多。在第2组中，按心力衰竭严重程度分层后，接受ACE抑制剂治疗的患者比未接受治疗的患者生存率更高。此外，对第3组的分析表明，β受体阻滞剂在意向性治疗和实际治疗中与传统治疗均有显著的相加作用。接受β受体阻滞剂治疗（通常联合洋地黄和ACE抑制剂）的轻度和中重度心力衰竭患者的4年生存率分别为90%和87.5%。
过去15年扩张型心肌病患者生存率的提高可能是由于早期诊断、新的治疗方法以及入组患者临床特征的改变。
