Clinical Study Of Left Ventricular Reverse Remodeling Of Non-ischemic Dilated Cardiomyopathy

Background:Although marked improvement in left ventricular systolic function has been increasingly reported in non-ischemic dilated cardiomyopathy (NIDCM), data on recovery of normal left ventricular ejection fraction (LVEF) is rare to date. The present study was designed to determine the frequency of recovery of normal LVEF in a cohort of Chinese patients with NIDCM, to identify predictors of early (after1year follow-up) recovery, to evaluate the prognostic value of early recovery on long-term prognosis, and finally, to evaluate the risk of recurrence after recovery.Methods:A consecutive series of patients admitted between October2008and October2012with clinical diagnosis of NIDCM and LVEF of40%or less by echocardiography at presentation were followed up to identify those with recovery of normal LVEF, defined as an increase in LVEF to a final level of50%or greater. An array of variables at baseline regarded as potentially relevant to recovery was evaluated to identify predictors of early recovery using multivariate logistic regression analysis. Survival data based on the combined clinical events of cardiovascular death and heart transplantation were analyzed using the Kaplan-Meier method and compared using the log-rank test between patients with and those without early recovery. A prognostic survival model was established by using the Cox hazard proportional analysis from baseline parameters and the possible additive prognostic role of the presence of early recovery with respect to baseline variables was evaluated by means of receiver-operating characteristic (ROC) analysis. The risk of recurrence of systolic dysfunction after recovery, defined as a decrease in LVEF at least10%from recovery to a level of≤45%, was also evaluated.Results:A total of490patients with NIDCM were enrolled in this analysis. At1year follow-up,114patients (23.3%) had a recovery of normal LVEF, showing a significant increase in LVEF from30.4±5.8%at baseline to54.7±4.0%at1year follow-up. At last follow-up of27±15months, the frequency of recovery was31.2%(n=153). Multivariate logistic analysis showed that history of hypertension (OR=2.529, p=0.017), shorter symptom duration (OR=0.979, p<0.001), higher systolic blood pressure at presentation (OR=1.064, p<0.001) and smaller left ventricular end-diastolic diameter (OR=0.902, p<0.001) on echocardiogram at baseline were independent predictors of early recovery. Kaplan-Meier method survival analysis showed that early recovery was associated with better long-term prognosis in terms of transplant-free survival. Multivariate Cox regression analysis showed that baseline independent predictors for combined clinical events after evaluation of early recovery for surviving patients at1year were right ventricular diameter on echocardiogram, serum sodium and the use of a P-blocker on discharge, and incorporating the presence of early recovery added the prognostic power with a significant increase in area under the curve of ROC from0.694to0.840(p=0.002). However, among the153patients with recovery,15patients (9.8%) suffered from recurrence of systolic dysfunction at26±12months after recovery with a decrease in LVEF from56.5±3.8%to36.1±7.6%.Conclusion:Around one fourth to one third of a cohort of Chinese patients with NIDCM has shown a recovery of normal LVEF after a mean follow-up of1to2years on current optimal therapy, which was associated with some baseline clinical and echocardiographic variables. Early recovery was associated with better long-term prognosis in terms of transplant-free survival, and added the prognostic power of baseline parameters for combined clinical events. However, some recovered patients may experience recurrence of systolic dysfunction, highlighting the necessity of close long-term follow-up. Background:Emerging evidences have shown the potential of marked improvement in left ventricular ejection fraction (LVEF) in patients with recent onset cardiomyopathy (ROCM) on medical therapy. This study was designed to determine the frequency and to identify some predictors of recovery of normal LVEF in a cohort of Chinese patients with ROCM on contemporary optimal medical therapy.Methods:A consecutive series of patients hospitalized in a single tertiary for heart failure management between October2008and December2012with the clinical diagnosis of ROCM and LVEF of40%or less by echocardiography at presentation were followed up for at least12months to identify those with recovery of normal LVEF, defined as an increase in LVEF to a final level of50%or greater. Early recovery was defined as recovery of normal LVEF at1year after initial evaluation and late recovery referred to those beyond1year. An array of clinical and echocardiographic variables at baseline regarded as potentially relevant to the recovery was evaluated to identify some predictors using multivariate stepwise logistic regression analysis, and consequently to establish a predictive model which consisted of some simple baseline parameters.Results:A total of128patients with ROCM were enrolled in this study. After a mean follow-up period of31±13months,62patients (48%) had a recovery of normal LVEF, who showed a significant increase in LVEF from32±6%at baseline to58±5%at last follow-up (p<0.001), with a mean increase of26±8%. This increase in LVEF was associated with a marked decrease in left ventricular end-diastolic diameter (LVEDD) from63±5mm to52±4mm (p<0.001). For the62patients with recovery, the length of time required for recovery was10±9months, and the frequency of recovery of normal LVEF at6months,1year and2years after initial evaluation was24%(n=32),33%(n=42) and45%(n=58), respectively. Moreover, early recovery occurred in68%patients with recovery of normal LVEF. Multivariate analysis showed that recovery of normal LVEF was significantly associated with previous history of hypertension (OR=3.278, p=0.030), higher systolic blood pressure at presentation (OR=1.041, p=0.002), shorter QRS interval on electrocardiogram (OR=0.975, p=0.019), smaller LVEDD (OR=0.914, p=0.001) and greater LVEF by echocardiography (OR=1.123, p=0.005) at baseline. The model composed of such variables was shown to be of excellent calibration by Hosmer-Lemeshow test (p=0.132) and discriminatory capacity tested by the area under the curve (AUC) of Receiver Operative Characteristics (ROC) of0.860(95%CI:0.795-0.925; p<0.001). Conclusion:Nearly half of a cohort of Chinese patients with ROCM has shown a remarkable recovery of normal LVEF on current optimal medical therapy after a mean follow-up of about3years, and two thirds of them occurred early at1year after initial evaluation, which was associated with some history of hypertension, systolic blood pressure at presentation, electrocardiographic QRS interval, echocardiographic LVEDD and LVEF at baseline. Background:Although emerging evidences have shown the potential of left ventricular reverse remodeling (LVRR) on current medical therapy, neither the likelihood nor the clinical variables associated with its occurrence in idiopathic dilated cardiomyopathy (IDCM) is well delineated so far. This study was designed to determine the frequency and to identify some predictors of LVRR in a cohort of Chinese patients with IDCM on contemporary optimal medical therapy.Methods:A consecutive series of patients hospitalized in a single tertiary for heart failure management between October2008and October2012with the clinical diagnosis of IDCM, and left ventricular ejection fraction (LVEF) of40%or less, as well as left ventricular end-diastolic diameter (LVEDD) of>55mm for male or50mm for female by echocardiography at presentation were followed for at least12months to identify those with LVRR, defined as an increase in LVEF to a final level of50%or greater and a decrease in LVEDD to a final level of55mm or less for male or50mm or less for female. An array of clinical and echocardiographic variables at baseline regarded as potentially relevant to the LVRR was evaluated to identify some predictors using multivariate stepwise logistic regression analysis.Results:A total of240patients with IDCM on current medical therapy were enrolled in this study. After a mean follow-up period of30±14months,45patients (18.8%) had a LVRR, showing a significant increase in LVEF from32.4±5.9%at baseline to57.4±4.9%at last follow-up, with a mean increase of25.0±6.9%. This increase in LVEF was associated with a marked decrease in LVEDD from62.7±4.1mm to50.7±3.5mm, with a mean decrease of12.0±4.5mm. For the45patients with LVRR, the length of time required for LVRR was14±10months. Subgroup analysis showed that the frequency of LVRR in recent onset IDCM (symptom duration≤6months)(31.1%) was significantly higher than that (9.0%) of in chronic IDCM (symptom duration>6months)(p<0.01). Multivariate analysis demonstrated that LVRR was significantly associated with shorter symptom duration (OR=0.977,95%CI:0.961-0.993; p=0.005), higher systolic blood pressure at presentation (OR=1.033,95%CI:1.007-1.060; p=0.013), smaller LVEDD (OR=0.895,95%CI:0.858-0.933; p<0.001) and greater LVEF (OR=1.091,95%CI:1.015-1.173; p=0.018) by echocardiography at baseline.Conclusion:On current optimal medical therapy, some patients with IDCM may have a remarkable recovery of LVEF and LVEDD. namely LVRR, which was associated with symptom duration, systolic blood pressure at presentation, echocardiographic LVEDD and LVEF at baseline.