In order to evaluate the prognostic implications of either transmitral filling parameters and pulmonary artery capillary pressure, 35 patients (23 men, age 63 +/- 13 years, +/- SD) with idiopathic (n = 19) or ischemic (n = 16) dilated cardiomyopathy (NYHA class II-IV) underwent Doppler echocardiography and right cardiac catheterization. None of them had atrial fibrillation, severe mitralic valvular disease, a advanced atrial-ventricular heart block, or was pace-maker implanted. Two groups of patients were identified on the basis of status symptoms: Group 1 (n = 12; NYHA class IIa-IIb), Group 2 (n = 23; NYHA class III-IV). As to diastolic parameters, the 2 groups significantly differed in peak E velocity (p < 0.001), deceleration time (p < 0.001), E/A ratio (p = 0.0004), E wave duration (p < 0.05) and isovolumetric time relaxation (p < 0.05). A restrictive-type transmitralic filling (high mitral E wave velocity, low mitral A wave velocity, low deceleration time), was found in 4 (33%) patients of Group 1 and in 20 (86%) patients of Group 2. Group 2 patients had significantly higher pulmonary artery capillary pressure (p < 0.001) than Group 1 patients. During the follow-up (18 +/- 6 months; from 8 to 22 months), 6 patients experienced cardiac death (4 died of sudden death and 2 for congestive heart failure), 1 patient underwent cardiac transplantation, and 6 patients had deterioration of status symptoms. All of the 7 major cardiac events and 3 out of 6 deteriorations of status symptoms occurred in patients of Group 2. With a Cox analysis, deceleration time (beta-0.096, SE = 0.03, p < 0.005), pulmonary artery capillary pressure (beta-0.027, SE = 0.01, p < 0.001), and left ventricular ejection fraction (beta-0.098, SE = 0.32, p < 0.006) were predictive of major cardiac events. The univariate prognostic predictors were found to be: E/A ratio (r = 0.72, p < 0.05), deceleration time (r = -0.90, p < 0.05), and isovolumetric time relaxation (r = -0.74, p < 0.05). Assessment of transmitral filling by Doppler echocardiography is a simple, reproducible and noninvasive method, providing effective functional and prognostic information on patients with dilated cardiomyopathy. The correlation found between several transmitral filling parameters and pulmonary artery capillary pressure provides an accurate noninvasive estimation of hemodynamics in these patients.