Idiopathic dilated Cardiomyopathy: Analysis of 152 necropsy patients

Abstract

Certain clinical and cardiac necropsy findings are described in 152 patients aged 16 to 78 years (mean 45) with idiopathic dilated cardiomyopathy: 109 (72%) were men and 43 (28%) were women. Compared with the women, the men had a significantly (p < 0.05) shorter mean duration of chronic congestive heart failure (CHF) (43 vs 69 months), a higher percentage of habitual alcoholism (40 vs 24%) and a higher mean heart weight (632 vs 551 g). The male to female ratio among the 58 known alcoholics was 7.3:1 and among the 70 known nonalcoholics, 1.5:1 (p < 0.05). The mean duration of clinical evidence of CHF was similar among the known alcoholics and the known non-alcoholics (each 50 months). Of the 152 patients, 148 (97%) had clinical evidence of chronic CHF; in 114 patients it was the initial manifestation of idiopathic dilated cardiomyopathy, and in most it became intractable and caused death. The interval from onset of chronic CHF to death (known in 120 patients) ranged from 1 to 264 months (mean 54). Comparison of the 27 patients surviving >72 months after onset of chronic CHF to the 64 patients surviving < 0.05). Electrocardiograms in the last 6 months of life in 101 patients disclosed atrial fibrillation in 25; complete left (41 patients) or right (6 patients) bundle branch block or indeterminate intraventricular conduction delay (4 patients) in 51 patients; QRS voltage indicative of ventricular hypertrophy in 44 patients (left ventricular in 39 patients). The patients with left bundle branch block compared with those without had a significantly longer duration of CHF, (83 vs 43 months), larger mean heart weights (628 vs 590 g) and a higher frequency of grossly visible scars (44 vs 13%). The total 12-lead QRS amplitude in 35 men ranged from 74 to 250 mm (mean 147) (10 mm = 1 mV) and in the 14 women from 75 to 243 mm (mean 167). The hearts at necropsy in the women ranged from 360 to 860 g (mean 551) and in the men from 400 to 940 g (mean 632) (p < 0.05). Grossly visible left ventricular scars were observed in 22 (14%) patients. Histologic examination (96 patients) of sections of the ventricular myocardium disclosed interstitial or replacement fibrosis in 55 patients (57%), and inflammatory cell infiltrates in 5 patients. © 1987.