Dilated cardiomyopathy natural history, complications and prognosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

There are several prognostic indicators when evaluating dilated cardiomyopathy, the most important one being ejection fraction. Complications as a result of dilated cardiomyopathy include heart failure, aortic and mitral valve regurgitation, emboli, edema, arrhythmias and sudden cardiac arrest.

Natural History, Complications, and Prognosis

Complications

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  Kidney: Infarct Remote: Gross external view with capsule removed two old and very typical infarct scars 27 year old person with dilated cardiomyopathy
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  Brain: Infarct: Healing large MCA and PICA probably embolic 64 year old female chronic obstructive pulmonary disease and cardiomyopathy with atrial fibrillation

Prognosis

There are many prognostic factors which can be evaluated in a patient with dilated cardiomyopathy. The most important prognostic indicator is a decreased ejection fraction, in addition increased left ventricular size and right ventricular dilation are independent indicators of a poor prognosis. As is in most types of heart failure a poor NYHA functional class and increased PASP (>35mmHg) are also poor prognostic indicators. Other findings that infer a poor prognosis are as follows: Maximal O2 uptake of < 12mL/kg / minute on exercise testing, LBBB (left bundle branch block), non sustained ventricular tachycardia, syncope, hyponatremia with a serum sodium less than 135, elevated norepinephrine, ANP (atrial natriuretic peptide) and renin levels (not routinely measured in clinical practice), elevated PCWP (pulmonary capillary wedge pressure) > 18mmHg and low cardiac index < 2.5L/min/m^2.