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What is the life span of a person with idiopathic dilated cardiomyopathy?

Answered by: Dr. U. Kaul
Director, Interventional Cardiology & Cardiac Electrophysiology,
Batra Hospital,
New Delhi

Q. My family member aged 62 years has been diagnosed with idiopathic dilated cardiomyopathy. An ECG, echo-cardiogram and subsequently cardio-angio-graph was done, EF was 35%. The doctor told us that the normal life for such patients is 6 months to 3 years, and another 3-4 years with a pacemaker. Is this true? My uncle had been diagnosed with dilated cardiomyopathy (with EF of 39%), when he was 45 years old. His reports are more or less similar, though the diagnosis was not idiopathic. Is this what is causing the difference in the prognosis? I have read reports on various web sites also which are not very hopeful. I am not able to understand the difference in the two cases.

A.  In general symptomatic patients with heart failure especially due to cardiomyopathy have a relatively poor prognosis. The LVEF below 40% is an adverse factor. This is true for all causes of low LVEF, which are not amenable to methods of treatment that increase the LVEF (patients without reversible causes, and cardiomyopathy is one of them). The patients who have a reversible cause such as a valvular heart disease and ischaemic heart disease with reversible ischaemic have a better prognosis. The term cardiomyopathy in general is reserved for cases where cause of low LVEF is not discernable (idiopathic). The medical treatment has improved over the years. Drugs that increase longevity in these situations are; ACE inhibitors, beta-blockers and a drug called spironolactone. A select group of cases, who have LBBB in ECG and have severe symptoms, do well with a special pacemaker called biventricular pacemaker, which resynchronises the heart beat affected by LBBB. When this device is combined with an impantable defibrillator (combo device) recent studies have shown that mortality is reduced significantly because sudden death due to VF can be aborted. Despite these observations, to predict the prognosis of a given case precisely is not easy. Statistics are not easy to apply to one or two patients. There would always be anecdotes where patients, despite severe disease, live for decades.

A.  In general symptomatic patients with heart failure especially due to cardiomyopathy have a relatively poor prognosis. The LVEF below 40% is an adverse factor. This is true for all causes of low LVEF, which are not amenable to methods of treatment that increase the LVEF (patients without reversible causes, and cardiomyopathy is one of them). The patients who have a reversible cause such as a valvular heart disease and ischaemic heart disease with reversible ischaemic have a better prognosis. The term cardiomyopathy in general is reserved for cases where cause of low LVEF is not discernable (idiopathic). The medical treatment has improved over the years. Drugs that increase longevity in these situations are; ACE inhibitors, beta-blockers and a drug called spironolactone. A select group of cases, who have LBBB in ECG and have severe symptoms, do well with a special pacemaker called biventricular pacemaker, which resynchronises the heart beat affected by LBBB. When this device is combined with an impantable defibrillator (combo device) recent studies have shown that mortality is reduced significantly because sudden death due to VF can be aborted. Despite these observations, to predict the prognosis of a given case precisely is not easy. Statistics are not easy to apply to one or two patients. There would always be anecdotes where patients, despite severe disease, live for decades.

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