Sixteen of 75 patients with dilated cardiomyopathy (DCM) died during a mean follow-up period of 39.7 months. In non-survivors, the cardiothoracic ratio and the left ventricular end-diastolic dimensions were greater, the left ventricular end-diastolic pressures were more elevated, and the cardiac index was lower than in the survivors at the time of initial diagnosis. There were no significant differences between survivors and non-survivors in the magnitude of the maximum QRS and T vectors or in the maximum T angle. In the non-survivors, the maximum QRS vector was directed more posteriorly and the width/length ratio of the loop in the horizontal plane was smaller than in survivors. The QRS loop in the horizontal plane was often distorted in non-survivors or showed a bizarre figure-of-eight configuration. It appears that in DCM a marked posterior displacement of a QRS loop that is narrow and distorted or is in a bizarre figure-of-eight configuration in the horizontal plane indicates an unfavorable prognosis.