BackgroundImprovement in the left ventricular ejection fraction (LVEF) may occur in patients with dilated cardiomyopathy (DCM).HypothesisThere are different implications of persistent versus transient improvement in LVEF among DCM patients receiving contemporary therapy.MethodsWe studied 188 patients with nonischemic DCM. Persistent improvement in LVEF (PIEF) was defined as LVEF increase by at least 10% compared to baseline, and found in 2 separate echo‐Doppler exams performed at least 12 months apart. Increased LVEF in echo 2, which was not sustained in echo 3, was defined as transient improvement in LVEF (TIEF).ResultsOver an average follow‐up of 6.8 years, PIEF occurred in 61 (33%) patients, predicting a better long‐term outcome (P < 0.001) in a combined end‐point comprising death, heart transplantation, or the need for a ventricular assist device. The TIEF group had an intermediate course and were closer to nonimprovers (P = 0.003 vs PIEF). Multivariate logistic regression identified the following independent predictors of PIEF: shorter disease duration, pregnancy‐associated disease, left ventricular hypertrophy, and baseline LVEF ≤25%. A score to predict PIEF assigned 1 point to each of the following: disease duration <3 years and no familial cardiomyopathy; pregnancy‐associated presentation; basal LVEF ≤25%; and left ventricular wall thickness ≥12. A score of ≥3 was present in 44% of the patients, reliably predicting PIEF in 91% (P = 0.01).ConclusionsPersistent improvement in LVEF is associated with improved long‐term prognosis. Baseline clinical parameters can be used to identify patients likely to demonstrate PIEF, thereby allowing tailored management in this population.
Background: Functional mitral regurgitation (MR) is a common finding in dilated cardiomyopathy. Left ventricular (LV) reverse remodeling with LV size reduction and improvement in LV function is a well recognized phenomenon. We aimed to evaluate the impact of LV remodeling on the mechanism leading to functional MR.
Methods: Among 188 patients with non-ischemic dilated cardiomyopathy, 10 patients significantly improved their LV function, reduced LV size and MR severity during follow-up (RRMR). A comparison was made between their baseline and follow-up echocardiographic examinations and to a matched-control group of patients who did not improve (no RRMR). LV and left atrium (LA) dimensions and volumes, LV mass (LVM), LV ejection fraction (LVEF)( follow-up (p < 0.04 for all). When compared to no RRMR, despite a similar ERO (0.2 ± 0.05 vs. 0.2 ± 0.08, p = 0.13) and a larger regurgitant volume (38 ± 9 vs. 29 ± 8 mL, p = 0.05) and despite similar clinical characteristics and medical treatment we found significantly higher LVEF, smaller LV dimensions and volumes, smaller LVM and SI in the RRMR group (p < 0.05 for all). On multivariable analysis the SI was the sole predictor of RRMR (p = 0.04, OR = 0.76,. Conclusions: Reverse remodeling characterized by improvement in LV function, reduction in LV size and an associated reduction in MR severity is related to LV SI at baseline. (Cardiol J 2015; 22, 4: 391-396)
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