Cardiac involvement is always detectable in the advanced stage of DMD but only a minority of patients suffer severe cardiac manifestations. In order to verify the existence of parameters that could help to predict the occurrence of cardiac findings, we investigated the cardiorespiratory involvement in 83 patients affected by DMD with a mean age of 17.2 years (range 7-27). In 65 cases the diagnosis was supported by the absence of dystrophin on muscle biopsy, the presence of an out of frame deletion in the dystrophin gene, or both. In all patients the clinical history was typical. During a 3-years follow-up period, 2D and colour Doppler echocardiography, ECG-Holter monitoring and respiratory tests were performed every 6 months in all patients. Based on echocardiographic results, the patients were classified in 4 groups. Twenty-nine (35%) patients belonged to group 0 (normal echocardiographic examination), 20 (24%) to group 1 (1 hypo-akinetic cardiac segment), 15 (18%) to group 2 (2-3 hypo-akinetic cardiac segments), 19 (23%) to group 3 (several cardiac segments with hypo-akinesia with or without enlargement of the left ventricular cavity). A statistical difference in the mean age was found between group 0 and each other group (P < 0.05), while no differences were found among groups 1 to 3. Similarly, the forced vital capacity was significantly higher in group 0 patients with respect to the other groups (P < 0.05) but not statistically different among groups 1 to 3. Our study confirm that cardiac involvement, in DMD, is not strictly dependent on age and respiratory function; patients in group 3 are likely to develop unpredictable severe cardiac manifestations and need a strict surveillance.