Persistent Recovery of Normal Left Ventricular Function and Dimension in Idiopathic Dilated Cardiomyopathy During Long‐Term Follow‐up: Does Real Healing Exist?

Abstract

BackgroundAn important number of patients with idiopathic dilated cardiomyopathy have dramatically improved left ventricular function with optimal treatment; however, little is known about the evolution and long‐term outcome of this subgroup, which shows apparent healing. This study assesses whether real healing actually exists in dilated cardiomyopathy .Methods and ResultsPersistent apparent healing was evaluated among 408 patients with dilated cardiomyopathy receiving tailored medical treatment and followed over the very long‐term. Persistent apparent healing was defined as left ventricular ejection fraction ≥50% and indexed left ventricular end‐diastolic diameter ≤33 mm/m2 at both mid‐term (19±4 months) and long‐term (103±9 months) follow‐up. At mid‐term, 63 of 408 patients (15%) were apparently healed; 38 (60%; 9% of the whole population) showed persistent apparent healing at long‐term evaluation. No predictors of persistent apparent healing were found. Patients with persistent apparent healing showed better heart transplant–free survival at very long‐term follow‐up (95% versus 71%; P=0.014) compared with nonpersistently normalized patients. Nevertheless, in the very long term, 37% of this subgroup experienced deterioration of left ventricular systolic function, and 5% died or had heart transplantation.ConclusionsPersistent long‐term apparent healing was evident in a remarkable proportion of dilated cardiomyopathy patients receiving optimal medical treatment and was associated with stable normalization of main clinical and laboratory features. This condition can be characterized by a decline of left ventricular function over the very long term, highlighting the relevance of serial and individualized follow‐up in all patients with dilated cardiomyopathy, especially considering the absence of predictors for long‐term apparent healing.

Epidemiology, pathophysiology and clinical outcomes for heart failure patients with a mid‐range ejection fraction

“…In this regard, it is equally interesting to note that patients with HFmrEF continue to have significant number of HF events, including death, and that the magnitude of these events was not significantly different from patients with HFpEF. The observation that HFmrEF patients with an improved LVEF continue to have recurrent HF events is consistent with prior reports which have shown that recovery of LV function is not necessarily associated with freedom from future HF events . A second unique observation in the present study was that the HFmrEF deteriorated patients had significantly more advanced diastolic dysfunction that the HFmrEF improved subgroup of patients, suggesting that despite having a similar LVEF the underlying pathophysiological substrate of HFmrEF is not uniform and depends on the underlying aetiology of HF.…”

Sex‐ and age‐based differences in the natural history and outcome of dilated cardiomyopathy

“…This cohort, although large, was enrolled in a single centre and has a relatively low prevalence of common co‐morbidities such as diabetes mellitus. It is possible that this reflects a degree of selection bias; however, our referral base is broad, from specialist and non‐specialist centres and the baseline characteristics are similar to other cohorts . The referral characteristics and specifically the proportion of men and women referred remain stable over the study period (online supplementary Figure S1).…”

The Prognostic Impact of the Evolution of RV Function in Idiopathic DCM

“…Therefore, deterioration in RVF might reflect the intrinsic progression of the cardiomyopathy process that typically characterizes DCM in the long term (22). The measurement of tricuspid annular plane systolic excursion as a simple parameter of RVF was not considered in our series because it was available only in a minority of patients and its reliability in assessing global RVF is questionable.…”