Malignancies limiting 5 year survival. <5 year life expectancy. Swelling of your … Transudative effusions develop when there is a change … If the cause of dilated cardiomyopathy is myocarditis, children are more likely to improve and have a better outcome than children with other causes of dilated cardiomyopathy. Donate. Any investigational drug trial within 30 days. Professionals. Recovery from postpartum cardiomyopathy in 2 patients by blocking prolactin release with bromocriptine. But a day after her birth, I unknowingly experienced over two liters of blood loss due to hemorrhaging. An image of your heart will show whether it's enlarged. The Lead Consultant then spoke directly to me and said that i was extremely rare because usually in Post Partum Cardiomyopathy, people don't recover this late on after no improvement during the first 6 months. Introduction. Cardiomyopathy makes it more difficult for your heart to pump blood to the rest of the body. Alcoholic cardiomyopathy causes enlargement and weakening of the heart muscle due to long-term alcohol abuse. (1994) found an R719W mutation in exon 19 changing the charge of the amino acid by -1. Peripartum cardiomyopathy (PPCM) is a form of dilated cardiomyopathy that is defined as deterioration in cardiac function presenting typically between the last month of pregnancy and up to five months postpartum.As with other forms of dilated cardiomyopathy, PPCM involves systolic dysfunction of the heart with a … The incidence is rare – 1 in 50,000 to 250,000 people and is ~5% of all EDS cases. Abstract Dilated cardiomyopathy (DCM) is the most common type of cardiomyopathy and is often viewed as a “final common pathway” of numerous types of cardiac injuries. Am J Obstet … Without diagnosis and treatment, the risk of dying as a woman with PPCM is great. If discovered and monitored the pregnancy can continue with little interruption. Cardiomyopathy can be life-threatening and can shorten your life expectancy if severe damage occurs early on. Arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C), which has a prevalence of 1:1,000 to 5,000, is an inherited disease of desmosomal proteins that is characterized by fibrofatty infiltration of healthy myocardium.19,20 This process leads to thinning and ballooning of the ventricular wall, typicall… Considered or listed for organ transplantation or history of organ transplantation; Illness other than HF with life expectancy less than 12 months. 7,8 Prognosis in ATTR amyloidosis … In order to remedy this as best as you can, you will need to put more focus on fruits and vegetables and minimize foods that have high sodium. The graph above shows trends in pregnancy-related mortality ratios between 1987 … J Am Coll Cardiol 2007;50:2354–5. An irregular heart beat and fainting may occur. Peripartum cardiomyopathy (PPCM) is an idiopathic form of cardiomyopathy presenting with heart failure secondary to left ventricular (LV) dysfunction towards the end of pregnancy or in the months following delivery, where no other cause of heart failure is identified. Cardiac failure in a previously healthy woman in the last month of pregnancy or within 5 months of delivery.2. postpartum cardiomyopathy Donna731 Hello, I am 29 years old, female and I was diagnosed with cardiomyopathy 2 years ago, hospitalized for 7 days, after the birth of my 2 year old daughter. When it occurs after delivery, it’s sometimes called as postpartum cardiomyopathy. Most will notice that they … Hypertrophic cardiomyopathy; Stroke within 3 months; Clinically significant renal failure (Cr >2.5), hepatic failure, or hematologic disorder; Malignancies limiting 5 year survival <5 year life expectancy; Contraindication to ARBs; Prior double-blind treatment in a valsartan HF trial; Any investigational drug … Life expectancy of cardiomyopathy patients can vary by etiology, though for most patients who develop HFthe mortality rate is 20 percent at one year and 70 to 80 percent at eight years (9). C. Cristina Quarta, M.D., and Scott D. Solomon, M.D. It is a rare condition that can carry mild or … Contraindication to ARBs. 20th March 2015. However, the life expectancy of cardiomyopathy varies from person to person, and different severities may have different life expectancies. Hereditary lymphedema type IA (Milroy’s disease) is characterized by swelling (edema) that is present at or shortly after birth (congenital). Cardiomyopathies are diseases of the myocardium associated with cardiac dysfunction, often resulting in the clinical syndrome of … Hypertrophic cardiomyopathy is a progressive and chronic condition that worsens over time if not treated promptly … Many factors such as age, hypertension, diabetes, smoking will trigger it. Because chemotherapy options have greatly expanded in recent years, prognosis for AL amyloidosis has markedly improved as well, with the life expectancy of most patients, including many of those with significant cardiac involvement, measured in years rather than months. Pleural effusions are commonly seen in patients with congestive heart failure. Peripartum cardiomyopathy (PPCM) establishes late in pregnancy or in the first postpartum months. Although it is not a curable condition, the signs and symptoms can usually be managed successfully and patients can have a good life expectancy. Cardiomyopathy affects the shape, function, and electrical system of the heart. Today’s treatments from hypertrophic cardiomyopathy (HCM) have improved so much that mortality in adults from the disease is close to death rates in … Young people. On November 8, 2016, my husband and I welcomed our second child, a beautiful baby girl, into the world on her daddy’s birthday. If your doctor thinks you have cardiomyopathy, several tests may be done to confirm the diagnosis, including: Chest X-ray. As the disease worsens, shortness of breath, feeling tired, and swelling of the legs may occur, due to the onset of heart failure. Cardiomyopathy is a group of diseases that affect the heart muscle. Pleural effusions are commonly seen in patients with congestive heart failure. How we can help. Current average five-year survival rates for children with dilated cardiomyopathy are 40–50%. Am J Obstet Gynecol. Key Words: cardiomyopathy † congenital heart disease † pregnancy † pulmonary hypertension P ulmonary hypertension (PH) is a disease characterized by debilitating symptoms and an overall diminished life expectancy because of narrowing of the pulmonary vascula-ture, often leading to right heart failure. Depends: The life expectancy of a person with cardiomyopathy (cm) depends on several variables.What is the cause of the cm?What is the amount of damage to the heart muscle?-usually reflected in a measurement of the heart's pumping ability known as an ejection fraction (the normal minimum is ~50-55%).A person's functional status is also important-are they very symptomatic on … peripartum cardiomyopathy.Key words: congestive heart failure, maternal complications, peripartum cardiomyopathy, postpartum complications, pulmonary edema P eripartum cardiomyopathy (PPCM) is a rare, po-tentially lethal complication of pregnancy. The presentation and identification of cardiovascular disease in women pose unique diagnostic challenges compared to men, and underrecognized conditions in this patient population may lead to clinical mismanagement. My EF was 45% when they found it, though it was probably much less, as they estimate I had the issue for at least 4 mths prior to finding it. Cardiomyopathy is a subacute or chronic disease of cardiac muscle, and the cause may be unknown. Cardiomyopathy affects the shape, function, and electrical system of the heart. 48 Preeclampsia and eclampsia are the most commonly studied hypertensive disorders of pregnancy and have been associated with increased CVD morbidity and mortality postpartum. Peripartum cardiomyopathy (PPCM) is a rare, often dilated, cardiomyopathy with systolic dysfunction that presents in late pregnancy or, more commonly, the early postpartum period. Ehlers-Danlos Syndrome (EDS) is a clinically and genetically heterogenous group of heritable connective tissue disorders due to altered collagen metabolism. Peripartum cardiomyopathy is a potentially life-threatening pregnancy-associated disease that typically arises in the peripartum period and is marked by left ventricular dysfunction and heart failure. 1 Peripartum cardiomyopathy is a global disease that occurs in about 1 in 1000 pregnancies, with a mortality rate ranging from 5% to 30%. Thus, greater life expectancy in short-term and long-term follow-up and the good evolvement of a subsequent pregnancy 13-15 do not justify ruling out pregnancy in women who experienced peripartum cardiomyopathy in a previous pregnancy, but who recovered left ventricular function. 43 old female, 165 lbs; cardiomyopathy, related to live birth 2 years ago. Enrolled in an interventional trial or received an experimental drug or device within 30 days of randomization. In the United States, over 50% of PPCM patients experience complete recovery of heart function (EF 55% or greater). 2 doctor answers • 2 doctors weighed in. This is a form of dilated cardiomyopathy, and it’s a life … Although it is not a curable condition, the signs and symptoms can usually be managed successfully and patients can have a good life expectancy. request uri=/whats-the-life-expectancy-of-a-60-year-old-with-ischemic-cardiomyopathy/ Echocardiogram. According to the American Family Physician, 20% of the patients may die from cardiomyopathy one year after diagnosis; 70%-80% of the patients may die from cardiomyopathy eight years after diagnosis. EJF than 15% now around 40%. I Developed Peripartum Cardiomyopathy After Childbirth, And This Is What People Should Know. Life expectancy greater than 12 months. Peripartum cardiomyopathy (PPCM, also called pregnancy-associated cardiomyopathy) is a rare cause of heart failure (HF) that affects women late in pregnancy or in the early puerperium [ 1 ]. In the United States, incidence varies from 1 in 1,000 to 1 in 4,000. Clinical evaluation, chest x-ray, M-mode and two-dimensional echocardiogram, exer- cise test, 72-h ambulatory electrocardiogram monitoring, and Persistent cough or wheezing with white or pink blood-tinged phlegm 7. Nonetheless, controlling the complications and symptoms derived due to different forms of cardiomyopathy is controllable with the help of medication, lifestyle changes, and surgery. This test … Cardiomyopathy can be life-threatening and can shorten your life expectancy if severe damage occurs early on. Since the Pregnancy Mortality Surveillance System was implemented, the number of reported pregnancy-related deaths in the United States steadily increased from 7.2 deaths per 100,000 live births in 1987 to 17.3 deaths per 100,000 live births in 2017. Authored by Corinne Bott-Silverman of the Cleveland Clinic. This can cause a previously completely healthy woman to suddenly experience heart failure within a couple of hours or days, and sometimes even months after child delivery. If it's caught early you could be ok, if it's spotted due to heart failure then realistically the condition has gone too far and all doctors can do is try to prevent further heart failure for as long as possible. This could last anywhere between 5 and 10 years depending, like I say, on the severity of the condition. I am recovering from a post partum cardiomyopathy, slightly different fish, but same problem. We were all so excited. Peripartum (Postpartum) Cardiomyopathy: This fairly rare condition is where an expectant mother’s heart enlarges and weakens as a result of the pregnancy. Stroke within 3 months. In cardiomyopathy, the heart muscle becomes thick or rigid, which can weaken the heart. Long-term mortality risk and life expectancy following recurrent hypertensive disease of pregnancy. This is a type of dilated cardiomyopathy, and it’s a life-threatening condition. The extent and location of edema varies greatly from case to case even among individuals in the same family. Dilated and Restrictive Cardiomyopathies Online Medical Reference - covers diseases of the myocardium associated with cardiac dysfunction. The four stages of dying from congestive heart failure will affect each patient differently, but there are certain symptoms and affects that most patients will experience. Food & Nutrition Diet (Meal Plan) for Cardiomyopathy #1 Recommended Breakfast Diet for Cardiomyopathy Although initially described in 1849 [ 2 ], it was not recognized as a distinct clinical entity until the 1930s [ 3 ]. The disease is relatively uncommon, but its incidence is rising. People with hypertrophic cardiomyopathy have near normal life expectancy. An enlarged heart may cause fatigue, chest pain, and edema. I think about 4mths on, with meds I had only progressed to … However, the life expectancy of cardiomyopathy varies from person to person, and different severities may have different life expectancies. EJF than 15% now around 40%. Dilated cardiomyopathy (DCM) is a condition in which the heart's ability to pump blood is decreased because the heart's main pumping chamber, the left ventricle, is enlarged and weakened.In some cases, it prevents the heart from relaxing and filling with blood as it should. Learn about the diseases and conditions that may cause an enlarged heart, and read about the medications used in treatment. M(>thod.s: This was a prospective cohort analysis of 123 pa- tients with dilated cardiomyopathy. I … CSANZ Guidelines for the diagnosis and management of Familial Dilated Cardiomyopathy Page 2 of 4 Family history: A detailed family history and a high level of clinical suspicion are essential. While inherited gene defects alone may be sufficient to cause disease, some individuals in Hypertension during pregnancy is a well-established risk factor for CVD postpartum. Have an increase in symptoms and not being seen. Postpartum cardiomyopathy patient of 3yrs, ejection 25. Definitions Objective To determine whether hypertensive disorders of pregnancy are associated with cardiomyopathy … 1. This rare type occurs when the heart weakens within five months of postpartum (delivery) or within the last month of pregnancy. In 4 unrelated families with hypertrophic cardiomyopathy (CMH1; 192600) with a high incidence of premature death and an average life expectancy in affected individuals of 38 years, Anan et al. Although the condition is prevalent worldwide, women with black ancestry seem to be at greatest risk, and the condition has a particularly high incidence in Nigeria and Haiti. Pinpoint your symptoms and signs with MedicineNet's Symptom Checker. Hypertrophic or infiltrative cardiomyopathy. Peripartum Cardiomyopathy (PPCM) is a form of heart failure during the systolic phase of pumping i.e. Over time, it can affect the other heart chambers. 56,57 Bokslag et al 58 investigated CVD risk in the fifth decade of life … Cardiomyopathy prognosis. Postpartum cardiomyopathy was diagnosed afterward by echocardiography. They are usually bilateral or right sided and are rarely left sided. Cardiomyopathy is a type of heart failure.Based on clinical studies, one in five people will develop heart failure in their lifetime. The majority of patients with hypertrophic cardiomyopathy have no symptoms and most have a near-normal life expectancy. September 13, 2018. It is commonly caused by a defect in the COL3A1 gene, most of which are single base substitutions, but more than 700 … This cardiomyopathy did not go away months after childbirth and in 2009, at the age of 40, was finally classified correctly as left ventricular noncompaction cardiomyopathy, which is a genetic cardiomyopathy. Learn more about causes, risk factors, screening and prevention, signs and symptoms, diagnoses, and treatments for cardiomyopathy, and how to participate in clinical trials. There’s no known cause. This is a form of dilated cardiomyopathy, and it’s a life … Definitions Still, the condition is associated with a death rate as high as 25% to 50%. Cardiomyopathy may have no signs or symptoms and need no treatment. Tags:ischemic cardiomyopathy life expectancy My father, 60 years old, has ischemic cardiomyopathy with 40% heart function and an LVEF of 20%. Echocardiogram.This test uses sound waves to create images of the heart, which show its size and its … The reason I'm concerned is that my Dad died suddenly at 69 from restrictive cardiomyopathy, due to probably an … They can do this by slowing the decline of your heart’s condition or by providing technologies … When it occurs after delivery, it’s sometimes called postpartum cardiomyopathy. This could last anywhere between 5 and 10 years depending, like I say, on the severity of the condition. Type IV or vascular EDS (vEDS) is an autosomal dominant disorder that affects Type III procollagen protein synthesis. with dilated cardiomyopathy during a long-term follow-up. … This rare type occurs when the heart weakens within five months of delivery or within the final month of pregnancy. List of authors. Support us. the heart pumping with force to circulate blood in the body. I've been fatigued and today my heart rate is 118. Patients who have symptoms at a younger age often have higher mortality rates. Hypertrophic cardiomyopathy. Image 1 – Postpartum Cardiomyopathy showing … Cardiovascular diseases (CVD) in developing countries are now recognised as a major global health problem. Heart failure in peripartum period was first described in 1849. Postpartum cardiomyopathy can be very painful for patients. Cardiomyopathy, a disease of the heart, responds well to various treatment methods. Early on there may be few or no symptoms. Dilated cardiomyopathy is the most common cause of heart failure. Ability to understand and provide signed informed consent, or have a designated legal guardian or spouse legally able and willing to make such decisions on the subject's behalf. I hope he is well for many years to come. But other cases of cardiomyopathy, the disease develops quickly with severe symptoms, and serious complications occur. Most commonly, it occurs right after delivery. In the UK, the estimated incidence of cardiomyopathy is 1 in 500. (doi: 10.1016/j.jacc.2007.10.006) Habedank D, Kuhnle Y, Elgeti T, Dudenhausen JW, Haverkamp W, Dietz R. Recovery from peripartum cardiomyopathy after … alcoholic cardiomyopathy an hypertrophic wine restrictive addict dialated father beer postpartum : I had a rough childhood, in which my father physically abused me and my mother was an alcoholic/drug addict. Peripartum cardiomyopathy (PPCM) contributes to maternal death during or after pregnancy. The inheritance pattern is variable, but is mostly autosomal dominant, with a range of mechanisms including deficiency of collagen-processing enzymes, … In the UK, the estimated incidence of cardiomyopathy is 1 in 500. Prompt treatment with implantable defibrillators has considerably decreased the sudden death risk in the patients. In rare cases, edema may develop later in life. 1 Cardiology department, Regional … Consequently, it should not be a surprise that the symptoms of dilated cardiomyopathy are the classic symptoms … Definition of Maternal mortality rate: The maternal mortality rate (MMR) is the annual number of female deaths per 100,000 live births from any cause related to or aggravated by pregnancy or its management (excluding accidental or incidental causes). In some cases, sudden cardiac death is the first symptom of the illness. Chest X-ray.An image of your heart will show whether it's enlarged. Ronald A. Wyss' autopsy and medical ... its impact on life expectancy is not very … Postpartum Cardiomyopathy can either be self-limiting, temporary or it can progress towards a severe and life-threatening form of heart failure. Treatments can prolong your life. They are usually bilateral or right sided and are rarely left sided. Other risk factors include pre … This test uses sound waves to create images of the heart, which show its size and its motions as it beats. Active myocarditis or early postpartum cardiomyopathy (within the first twelve months … cessation of angiotensin-converting enzyme (ACE) inhibitors in the event of a positive pregnancy test. Stabilizing Transthyretin to Treat ATTR Cardiomyopathy. The counselling provides an opportunity for an up-to-date assessment of a woman’s cardiac condition and review of current medication, giving advice on changes that will be required in the event of pregnancy, e.g. It results from abnormal development of the heart muscle in the womb. Only one among every three patients survive for more than five years. Cardiomyopathies are classified into four categories on the basis of abnormalities in structure and function: dilated cardiomyopathy, hypertrophic cardiomyopathy, restrictive cardiomyopathy, and arrhythmogenic right ventricular cardiomyopathy. ... Mortality data presented include life expectancy, leading causes of death, and infant mortality. Postpartum cardiomyopathy is a rare form of congestive heart failure of unknown etiology. Many women with this form of Cardiomyopathy recover completely and have a normal life expectancy. Prompt treatment with implantable defibrillators has considerably decreased the sudden death risk in the patients. Still, the condition is associated with a death rate as high as 25% to 50%. 2. 1. The legs are most often affected. Peripartum cardiomyopathy is a weakness of the heart muscle that by definition begins sometime during the final month of pregnancy through about five months after delivery, without any other known cause. Cardiomyopathy is a general term for diseases of the heart muscle, where the walls of the heart chambers have become stretched, thickened or stiff. This affects the heart's ability to pump blood around the body. The heart cannot pump blood efficiently … Prognosis of peripartum cardiomyopathy in sub-Saharan Africa (Burkina Faso South-West PPCM register) Taryètba André Arthur Seghda 1 *, Théodore Boro 2, Jean Eudes Bambara 1, Kadari Cisse 3, Andrés Miguel Lopez 4, André K Samadoulougou 4 and Patrice Zabsonre 5. An important step in the evaluation of any pleural effusion is the classification of the fluid into a transudate or an exudate. This article reviews the sex differences in cardiovascular disease, explores the diagnostic and … Alcoholic cardiomyopathy is prevalent in men between 35 and 55 years of age, but it may affect any person addicted to alcohol for a long period of time. 90,000 U.S. doctors in 147 specialties are here to answer your questions or offer … Prior double-blind treatment in a valsartan CHF trial. Those affected are at an increased … Peripartum cardiomyopathy (PPCM), also known as postpartum cardiomyopathy, is an uncommon form of heart failure that happens during the last month of pregnancy or up to five months after giving birth. Cardiomyopathy literally means heart muscle disease. PPCM is a dilated form of the condition, which means the heart chambers enlarge and ... Long-term mortality risk and life expectancy following recurrent hypertensive disease of pregnancy. postpartum cardiomyopathy. Information. Ischemic cardiomyopathy is a common cause of heart failure. Cardiomyopathy. This rare type occurs when the heart weakens within five months of delivery or within the final month of pregnancy. You'll also be asked when your symptoms occur — for example, whether exercise brings on your symptoms. The current diagnostic criteria for peripartum cardiomyopathy include1. Whether hypertensive disorders of pregnancy are also associated with cardiomyopathy later in life is unknown. Almost all recovered patients are eventually able to discontinue medications with no resulting relapse and have normal life expectancy. When it occurs after delivery, it’s sometimes called postpartum cardiomyopathy. . Your doctor will perform a physical examination and ask questions about your personal and family medical history. If your doctor thinks you have cardiomyopathy, several tests may be done to confirm the diagnosis, including: 1. Cardiomyopathy and other cardiovascular conditions, hemorrhage, and other chronic medical conditions are all important causes of death. Many patients recover well within the first year, but long‐term outcome studies on morbidity and mortality are rare. Life expectancy of a peripartum cardiomyopathy patient improves with proper treatment and monitoring of the heart condition. Peripartum cardiomyopathy (PPCM), also known as pregnancy-associated cardiomyopathy , is an uncommon condition in which an idiopathic form of left ventricular (LV) systolic dysfunction develops during pregnancy or the postpartum (PP) period in women without previous heart disease .The incidence of this condition in the United States is approximately 1 in 3,000 deliveries, … 0800 018 1024 Lines open Mon-Fri 8.30 am-4.30 pm. Clinically significant renal failure (Cr >2.5), hepatic failure, or hematologic disorder. Cardiomyopathy life expectancy depends on the causes, types and severity of the cardiomyopathy. The diagnosis of nonischemic DCM is established by the absence of significant coronary artery disease and prior myocardial infarction (MI). Although the life expectancy of patients with cardiomyopathy varies by etiology, the mortality rate is 20 percent at one year and 70 to 80 percent at … Peripartum cardiomyopathy occurs during or after pregnancy. Peripartum Cardiomyopathy Images Peripartum cardiomyopathy 1. Importance Women with hypertensive disorders of pregnancy, preeclampsia in particular, have an increased risk of cardiomyopathy during the peripartum period. The disease is also progressive, which means it tends to get worse over time. Cardiomyopathy refers to diseases of the heart muscle. Prospective studies, with a greater cohort … Relief for symptoms varies, depending on the type of cardiomyopathy, and includes pacemakers, angiotensin-converting-enzyme inhibitors and diuretics, and procedures including myectomy, ablation and open-heart surgery. Previously healthy women present with often severe heart failure during the last month of pregnancy or the first months postdelivery. Cardiomyopathy and other cardiovascular conditions, hemorrhage, and other chronic medical conditions are all important causes of death. Many women with this form of Cardiomyopathy recover completely and have a normal life expectancy. Treatments can prolong your life. They can do this by slowing the decline of your heart’s condition or by providing technologies to help your heart do its job. Those with cardiomyopathy should make several lifestyle adjustments to improve heart health. These may include: One of the biggest challenges is sticking with a regular exercise program. Peripartum cardiomyopathy occurs during or after pregnancy. PPCM typically presents at late-stages pregnancy and in the early post-partum (after birth) period, if there are … In fact, most people—including many doctors—use the term "heart failure" as a virtual synonym for dilated cardiomyopathy. However, in 90 percent cases, doctors recommend women to avoid second pregnancy even when they have healthy heart, as there remains a … The following are key points to remember from this state-of-the-art review on peripartum cardiomyopathy (PPCM): PPCM is an idiopathic condition with left ventricular (LV) systolic dysfunction (ejection fraction [EF] ; 45%) towards the end of pregnancy or following delivery, when no other cause of heart failure (HF) is found. Should I go to the ER? Here, we present 5‐year follow‐up data of a German PPCM cohort. I asked what the life expectancy was..... 5 years, 80% of people in my position will have died. Nor Hidayah Zainool Abidin Supervisor : Dr Hasmizy 2. An important step in the evaluation of any Pregnancy in women Get help from a cardiomyopathy support nurse. According to WHO, in 2012, more than 75% of all deaths due to cardiovascular causes occurred in low and middle income countries (LMIC), where CVD occurs at a younger age, affecting profoundly the workforce and the … Email us. Stage 1: During the first stage, also referred to as the initial stage, patients may not experience any symptoms. Life expectancy of person with cardiomyopathy Download Here Free HealthCareMagic App to Ask a Doctor All the information, content and live chat provided on the site is intended to be for informational purposes only, and not a substitute for professional or medical advice. When it occurs after delivery, it’s sometimes called postpartum cardiomyopathy. N Engl J Med 2018; 379:1083-1084. It is de-fined as a cardiomyopathy … Caused by a defect in the evaluation of any pleural effusion is the symptom. This test … postpartum cardiomyopathy in 2 patients by blocking prolactin release with bromocriptine the diagnosis of DCM! 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