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R everse remodeling is known to occur in patients with de novo presentations of nonischemic dilated cardiomyopathy. Predictors include recent onset, female sex, higher left ventricular (LV) ejection fraction by echocardiography at baseline, higher systolic blood pressure, QRS width <120 ms (or absence of left bundle branch block) and normal LV dimensions. Conversely, increased LV size is regarded as a poor prognostic marker. 1 We present a case of a patient who presented with established cardiomyopathy and severe LV dilation that reverted to normal cardiac size and function after receiving standard heart failure therapy. Case ReportThe patient, a 45-year-old black man, was initially diagnosed with dilated cardiomyopathy after an admission to a community hospital with sinus tachycardia, dyspnea, and volume overload. He denied alcohol, drug, or stimulant use; had no risk factors for Human Immunodeficiency Virus; and had no family history of cardiomyopathy. The initial transthoracic echocardiogram revealed an ejection fraction of 21% with severe mitral regurgitation and LV end-systolic and end-diastolic dimensions (6.3 cm and 7.3 cm, respectively). Brain natriuretic peptide (BNP) was recorded as 368 pg/mL (Table). Cardiac catheterization demonstrated normal coronary arteries with a LV end-diastolic pressure of 17 mm Hg. He was discharged home on medical therapy including digoxin, carvedilol, and aldactone. For unknown reasons, neither an angiotensin-converting enzyme inhibitor nor angiotensin receptor antagonist was prescribed at that time. The patient was lost to follow-up and subsequently presented again to the same hospital 3 years later complaining of palpitations. A transesophageal echocardiogram revealed a LV ejection fraction of 10% and a BNP of 1086 pg/mL. He was diuresed and reinitiated on a comprehensive heart failure medication regimen before discharge.Because of ongoing medication nonadherence, the patient was readmitted on multiple occasions for decompensated heart failure and treated with intravenous diuresis. Several months after he represented, the LV end-diastolic dimension was measured at 8.92 cm ( Figure, A and B) on transthoracic echocardiography, confirmed on a transesophageal echocardiogram with a measurement of 10.0 cm. Serial laboratory evaluations including comprehensive metabolic panel, thyroid function tests including thyroid-stimulating hormone and free T4, iron studies, and complete blood counts were all within normal limits. One comprehensive toxicology screen was positive for marijuana. The patient was subsequently referred for possible transplant or ventricular assist device placement. At the time of our initial evaluation, the patient denied any significant heart failure symptoms and reported playing basketball 2 to 3 times weekly and working as a member of the maintenance staff for a sports club. His physical examination revealed a blood pressure of 110/60 mm Hg with a pulse of 90, elevated jugular venous pressure at 12 cm, a laterally displaced LV point of maximal impulse, and a g...

Background: The influence of gender on the risk for subsequent ischemic events (i.e., myocardial infarction, stroke, critical limb ischemia) in patients with coronary (CAD), cerebrovascular (CVD) or peripheral artery disease (PAD) is not well known. Patients and Methods: FRENA is an ongoing, observational registry of consecutive outpatients with symptomatic CAD, CVD, or PAD. We compared the incidence of subsequent ischemic events according to gender. Results: As of July 2008, 2607 patients had been enrolled, of whom 713 (27%) were women. Women were significantly older and had diabetes or hypertension more often than men. Over a mean follow-up of 14 months, 228 patients (8.7%) developed subsequent events (myocardial infarction 72; ischemic stroke 76; critical limb ischemia 98). Of these, 37 (16%) were fatal. On univariate analysis, women had an increased incidence of subsequent ischemic events than men (odds ratio: 1.3; 95% CI: 1.0-1.8). On multivariate analysis, any influence of gender had disappeared. The most common type of subsequent event was one that was identical to the patient's initial manifestation, but women experienced events in the same vascular bed more often than men, particularly women initially presenting with CVD: 92% of women vs 62% of men with CVD had subsequent stroke (odds ratio: 6.5; 95% CI: 1.5-4.7). Conclusions: Women had a higher incidence of subsequent ischemic events in the same vascular bed than men, particularly those with CVD. They also had a worse outcome than men, but this may be explained by the confounding effect of additional variables.