A clinical score for predicting left ventricular reverse remodelling in patients with dilated cardiomyopathy

Abstract

Aims Left ventricular reverse remodelling (LVRR) is a well-established predictor of a good prognosis in patients with dilated cardiomyopathy (DCM). The prediction of LVRR is important when developing a long-term treatment strategy. This study aimed to assess the clinical predictors of LVRR and establish a scoring system for predicting LVRR in patients with DCM that can be used at any institution. Methods and results We consecutively enrolled 131 patients with DCM and assessed the clinical predictors of LVRR. LVRR was defined as an absolute increase in left ventricular ejection fraction (LVEF) from ≥10% to a final value of >35%, accompanied by a decrease in left ventricular end-diastolic dimension (LVEDD) ≥ 10% on echocardiography at 1 ± 0.5 years after a diagnosis of DCM. The mean patient age was 50.1 ± 11.9 years. The mean LVEF was 32.2 ± 9.5%, and the mean LVEDD was 64.1 ± 12.5 mm at diagnosis. LVRR was observed in 45 patients (34%) at 1 ± 0.5 years. In a multivariate analysis, hypertension [odds ratio (OR): 6.86; P = 0.002], no family history of DCM (OR: 10.45; P = 0.037), symptom duration <90 days (OR: 6.72; P < 0.001), LVEF <35% (OR: 13.66; P < 0.0001), and QRS duration <116 ms (OR: 5.94; P = 0.005) were found to be independent predictors of LVRR. We scored the five independent predictors according to the ORs (1 point, 2 points, 1 point, 2 points, and 1 point, respectively), and the total LVRR predicting score was calculated by adding these scores. The LVRR rate was stratified by the LVRR predicting score (0-2 points: 0%; 3 points: 6.7%; 4 points: 17.4%; 5 points: 48.2%; 6 points: 79.2%; and 7 points: 100%). The cutoff value of the LVRR predicting score was >5 in receiver-operating characteristic curve analysis (area under the curve: 0.89; P < 0.0001; sensitivity: 87%; specificity: 78%). An LVRR predicting score of >5 was an independent predictor compared with the presence of late gadolinium enhancement on cardiovascular magnetic resonance or the severity of fibrosis on endomyocardial biopsy (OR: 11.79; 95% confidence interval: 2.40-58.00; P = 0.002). Conclusions The LVRR predicting score using five predictors including hypertension, no family history of DCM, symptom duration <90 days, LVEF <35%, and QRS duration <116 ms can stratify the LVRR rate in patients with DCM. The LVRR predicting score may be a useful clinical tool that can be used easily at any institution.

Clinical Effect of Pulmonary Artery Diameter/Ascending Aorta Diameter Ratio on Left Ventricular Reverse Remodeling in Patients With Dilated Cardiomyopathy

“…This score has better predictability for LVRR in patients with DCM compared with late gadolinium enhancement on cardiac magnetic resonance imaging or fibrosis severity according to EMB. 11 The present study showed the PAD/ AoD ratio still had significant predictability, even after adjusting for this clinical predictive score.…”

“…9,12, 32 We also evaluated the clinical score for predicting LVRR (LVRR predictive score) in patients with DCM using 5 predictors: history of hypertension (1 point), no family history of DCM (2 points), symptom duration <90 days (1 point), LVEF >35% (2 points), and QRS duration <116 ms (1 point). 11 Cardiac events included a composite of hospitalization due to worsening HF, lethal arrhythmia (hospitalization for hemodynamically unstable sustained ventricular tachycardia or ventricular fibrillation), LVAD implantation, and cardiac death. We collected outcome data using medical records or via telephone calls to patients or their families.…”

“…and several previous studies have attempted to determine the predictive factors for LVRR in patients with DCM. [10][11][12][13][14] Patients who will develop LVRR should be identified because this influences decisions and timing regarding certain aggressive therapies and non-pharmacologic interventions, such as implantable cardioverter defibrillators, cardiac resynchronization therapy, LV-assist devices (LVADs), and heart transplantation. 3 The ratio of main pulmonary arterial (PA) diameter (PAD) to ascending aortic diameter (AoD), assessed by computed tomography (CT), aids in evaluating dynamic cardiac volume status, and represents an indirect predictive measure for respiratory diseases, including chronic obstructive pulmonary disease, 15 idiopathic pulmonary fibrosis, 16 chronic thromboembolic pulmonary hypertension, 17 and pulmonary hypertension due to pulmonary embolism.…”

Baseline Blood Pressure and Left Ventricular Reverse Remodeling in Dilated Cardiomyopathy with Spontaneous Mechanical Alternans

“…Dilated cardiomyopathy (DCM) is a heterogeneous disease, and it is challenging to predict whether left ventricular functional recovery (left ventricular reverse remodeling [LVRR]) can be achieved (1)(2)(3). LVRR is indicative of a good prognosis and is achieved in about 40% of patients with DCM through optimal medical therapies (OMTs) (1)(2)(3)(4).…”

Early prediction of clinical scores for left ventricular reverse remodeling using extreme gradient random forest, boosting, and logistic regression algorithm representations

“…Limited information is available on factors predicting the improvement in left ventricular ejection fraction (LVEF) by implementing drug therapy in patients with HFrEF ( 6 , 7 ), and LVRR usually occurs within 1–2 years in patients who experience heart attacks ( 8 ). ICD implantation is recommended as the primary form of prevention in clinical guidelines only when the LVEF is re-evaluated to be 35% again in patients after at least 3–6 months of receiving optimal drug therapy ( 9 ). Therefore, if we can identify LVRR in combination with several common clinical diagnosis methods in patients with an EF of ≤35% (HFrEF) at first diagnosis, this will aid in determining whether ICD implantation should be performed to prevent sudden cardiac death.…”