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Study of clinical Profile X-Ray ECG and Echocardiographic Findings in Dilated Cardiomyopathy
ABSTRACT: OBJECTIVES: To study the clinical features of dilated cardiomy opathy. DESIGN: Cross-section study of thirty consecutive patients suffering from Dilated cardiomyopathy, admitted in Bir Hospital. SETTING: Dilated cardiomyopathy patients admitted under the department of medicine, Bir Hospital, a tertiary referral centre and post-graduate teaching hospital of His Majesty's Government of Nepal. MAIN OUTCOME MEASURE: The diagnosis of DCM was established by i) History and clinical examination ii) Chest x-ray and ECG iii) Echocardiography OBSERVATIONS: Thirty-four patients qualified for inclusion in the study, out of which thirty patients were found to have dilated cardiomyopathy. Sex distribution was equal in the study. Nearly 55% of the patients belonged to the age group of 50-69 years. All the patients had dyspnoea with 18 of the patients (60%) in New York Heart Assiciation (NYHA) class IV. Three patients were in NYHA class II and nine in class III. None of the patients belonged to the NYHA functional class L. Three cases had documented myocardial infarction in the past, two had peripartum cardiomyopathy, three had alcoholic cardiomyopathy and one had acromegalic cardiomyopathy. The cause was not obvious in other patients. The mean ejection fraction in NYHA functional class II, III and IV were 39.67, 30.0 and 29.07; and the mean cardio-thoracic ratio were 0.6, 0.58 and 0.65. The differences in both of these parameters were found to be statistically significant (p<0.05). The mean fractional shortening in these three classes were 18.47, 16.0 and 14.4 respectively. This was, however, not statistically significant (p>0.05). The commonest ECG changes were non-specific ST-T change (63.3%) followed by left ventricular hypertrophy (43.3%), left axis deviation (30%) and left bundle branch block (26.7%). Only 11 patients could be followed up; 4 patients had complete restoration of normal cardiac function, which included 2 patients with alcoholic cardiomyopathy and 1 with peripartum cardiomyopathy. CONCLUSION: The diagnosis based on clinical judgement, ECG changes and X-ray findings is fairly reliable (30 out of 34 patients had DCM diagnosed by echocardiography); provided dilated cardiomyopathy is considered as a possibility in patients presenting with heart failure. All the patients presenting to the hospital were symptomatic and manifested signs of overt heart failure. Most of the patients were in NYHA class IV and these patients also had larger CT-ratio and lower ejection fraction (both being statistically significant). Patients in NYHA class IV also had lower fractional shortening as compared to the patients in NYHA class II and III; this not being statistically significant. The follow-up rate is 36.7% only. Complete restoration of normal cardiac function is possible in alcoholic dilated cardiomyopathy presenting acutely and also in peripartum cardiomyopathy.