DOPPLER-ECHOCARDIOGRAPHIC ANALYSIS OF DIASTOLIC LEFT-VENTRICULAR FUNCTION TO ASSESS COURSE AND PROGNOSIS IN DILATED CARDIOMYOPATHY

The relationship between left-ventricular diastolic function and the course of the disease was investigated in a prospective study of 61 patients (44 men, 17 women; median age 51 [26-74] years) with dilated cardiomyopathy. The diastolic function was measured by recording the transmitral Doppler flow profile. During a follow-up period of 33 +/- 23 months, 15 patients died (twelve of progressive heart failure, three suddenly without previous heart failure). Cardiac transplantation was performed in four patients. The overall 1-year mortality rate was 14%. A >>restrictive<< Doppler echocardiographic filling pattern with a steep early-diastolic maximum and a small atrial filling component predominated in the patients who died from progressive heart failure or had a cardiac transplantation because of it. The deceleration of the early diastolic velocity maximum was clearly shorter than in the survivors (111 +/- 32 ms vs 194 +/- 62 ms; P < 0.001). In a Cox proportional hazard model the deceleration time was the best prognosticator, followed by the enddiastolic left-ventricular diameter (LV(D)). The group of patients with a short deceleration time (less than or equal to 140 ms) had a significantly higher 1-year mortality rate (28% [confidence interval a 9-47%]) than those in whom it was longer (3% [0-11%]; P < 0.0001). Taking into account LVD it proved possible to identify a prognostically especially unfavourable group with a 1-year mortality rate of 53% (26-80%), characterized by a LV(D) > 70 mm and a deceleration time less than or equal to 140 ms. Repeated echocardiography in 26 survivors and nine patients who died later or had been operated on showed that the deceleration time did not change significantly in the course of the disease. On the other hand, the systolic function, as measured by the echocardiographically determined shortening fraction, improved in the survivors (from 0.18 +/- 0.07 to 0.22 +/- 0.08; P < 0.05), but not in those who lateron died.