THE NATURAL-HISTORY OF IDIOPATHIC DILATED CARDIOMYOPATHY
THE NATURAL-HISTORY OF IDIOPATHIC DILATED CARDIOMYOPATHY
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DOI：
10.1016/0002-9149(81)90534-8
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发表时间：
1981-01-01
影响因子：
2.8
通讯作者：
FRYE, RL
中科院分区：
文献类型：
--
作者：
FUSTER, V;GERSH, BJ;FRYE, RL
在1960年至1973年期间，马约诊所共有104名患者根据临床和血管造影标准诊断为特发性扩张型心肌病;这些患者随访6至20年。21%的患者有过量饮酒史，20%的患者在出现心脏表现前60天内有严重的流感样综合征，8%的患者在几年前有风湿热，但没有累及心脏瓣膜;因此，感染免疫型可能是重要的病因危险因素。80名患者（77%）的死亡过程加速，其中三分之二的死亡发生在前2年内。24名患者（23%）存活，其中18名患者临床症状改善，心脏大小正常或缩小。诊断时的单因素分析显示三个因素对临床病程具有高度预测性（p < 0.01）：年龄、胸部X线片上的心胸比率和心脏指数。未接受抗凝治疗的患者中有18%发生全身性栓塞，接受抗凝治疗的患者中无一例发生全身性栓塞;因此，除非有禁忌症，否则可能应开具抗凝剂处方。
Between 1960 and 1973, a total of 104 patients at the Mayo Clinic had a diagnosis of idiopathic dilated cardiomyopathy on the basis of clinical and angiographic criteria; these patients were followed up for 6 to 20 years. Twenty-one percent of the patients had a history of excessive consumption of alcohol, 20 percent had had a severe influenza-like syndrome within 60 days before the appearance of cardiac manifestations and 8 percent had had rheumatic fever without involvement of cardiac valves several years before; thus, possible etiologic risk factors of infectious-immunologic type may be important. Eighty patients (77 percent) had an accelerated course to death, with two thirds of the deaths occurring within the first 2 years. Twenty-four patients (23 percent) survived, and 18 of them had clinical improvement and a normal or reduced heart size. Univariate analysis at the time of diagnosis revealed three factors that were highly predictive (p < 0.01) of the clinical course: age, cardiothoracic ratio on chest roentgenography and cardiac index. Systemic emboli occurred in 18 percent of the patients who did not receive anticoagulant therapy and in none of those who did; thus, anticoagulant agents should probably be prescribed unless their use is contraindicated.