Predictors of Left Ventricular Reverse Remodeling and Subsequent Outcome in Nonischemic Dilated Cardiomyopathy

Choi, Jin Oh; Kim, Eun Young; Lee, Ga Yeon; Lee, Sang‐Chol; Park, Seung Woo; Kim, Duk Kyung; Oh, Jae K.; Jeon, Eun Seok

doi:10.1253/circj.cj-12-0507

Cited by 47 publications

(40 citation statements)

References 17 publications

(6 reference statements)

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“…Recently, monitoring using cardiac imaging of the LV structure has proved to be clinically useful for predicting the long-term clinical prognosis of DCM. 21 In accordance with the previous study, 21 the presence of PH and LV remodeling contributed to cardiac death in the present study's DCM patients. In fact, our Kaplan-Meier curves suggested that cardiac events occurred frequently within 2 years in patients with DCM and PH.…”

Section: Prognosis Of Ambulatory Dcm Patients With Phsupporting

confidence: 93%

Prognostic Value of Pulmonary Hypertension in Ambulatory Patients With Non-Ischemic Dilated Cardiomyopathy

Hirashiki

Kondo

Adachi

et al. 2014

Circ J

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Section: Prognosis Of Ambulatory Dcm Patients With Phsupporting

confidence: 93%

Prognostic Value of Pulmonary Hypertension in Ambulatory Patients With Non-Ischemic Dilated Cardiomyopathy

Hirashiki

Kondo

Adachi

et al. 2014

Circ J

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“…Recently, some factors have been reported as predictors for LVRR, including higher systolic blood pressure, narrow QRS duration, small LV systolic dimension, and log BNP at baseline. 27,28) The polymorphism of β1-adrenergic receptors is also reported to affect LVRR after β-blocker therapy. 29) In our preliminary study, the change rate of log BNP, LVDd, and LVDs at enrollment were significant predictors for LVRR.…”

Section: Discussionmentioning

confidence: 99%

High Dose <i>β</i>-Blocker Therapy Triggers Additional Reverse Remodeling in Patients With Idiopathic Non-Ischemic Cardiomyopathy

et al. 2016

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SummaryCarvedilol has established its evidence to improve prognosis and facilitate left ventricular reverse remodeling (LVRR) in heart failure patients with reduced left ventricular ejection fraction (LVEF), and many studies have supported its dose-dependency. However, there are few studies demonstrating the effect of high dose carvedilol in Japan. We enrolled 23 patients with idiopathic non-ischemic cardiomyopathy, in whom LVEF remained 45% or less despite 20 mg/ day of carvedilol therapy for > 3 months. After high dose (40 mg/day) carvedilol therapy for > 3 months, LVEF improved (+9.1%, P = 0.002), and LV end-diastolic diameter (LVDd) and LV end-systolic diameter (LVDs) reduced (-4.6 and -6.9 mm, respectively, P < 0.05) compared with the baseline data. Finally, 17 patients achieved LVRR after the high dose, when LVRR was defined as 1) those with final EF > 45%, and 2) those with final EF < 45% but who attained increases in LVEF > 10%, or LVEF > 5% with a decrease in LV end-diastolic dimension index (LVDDI) > 5%. Baseline predictors for LVRR after high dose carvedilol were the change rates of log B-type natriuretic peptide (BNP), LVDd, and LVDs from the time of pre-carvedilol introduction to enrollment (P < 0.05, respectively). In conclusion, high dose carvedilol triggered additional LVRR in patients with idiopathic non-ischemic cardiomyopathy and the change rates of log BNP, LVDd, and LVDs at 20 mg carvedilol may be predictors for the additional LVRR at high dose. (Int Heart J 2016; 57: 717-724) Key words: Carvedilol, Heart failure, Ejection fraction β -Blockers (BBs) have established the evidence to improve the prognosis of chronic heart failure (HF) patients with reduced left ventricular ejection fraction (LVEF), [1][2][3] and are recommended as one of the first line drugs in all HF guidelines. 4,5) Among the 3 BBs that have been shown to be effective in systolic HF, ie, carvedilol, bisoprolol, and metoprolol succinate, carvedilol has been used the most all over the world. [6][7][8] The approved maximal dose is 20 mg/day in Japan, whereas its standard dose in the United States and Europe is 50 mg/day. HF guidelines from the US 4) and Europe 5) state that BBs should be titrated as much as tolerated. However, a post-marketing surveillance study in Japanese HF patients reported that carvedilol was then prescribed at approximately 7.2 mg/day on average. 9) Similarly, the mean dosage of carvedilol was 25 mg/day, ie, half of the target dose in Europe in the SHIFT study.10) As such, BBs are underused in terms of their dosage in real-world clinical practice.When a new drug is introduced into Japan, approximately the half dose of that in Western countries has often been adopted as the maximal dose for Japanese simply because of their smaller average build. In most Japanese clinical trials, the protocols set the target dose of any medications relatively low. This was also the case for carvedilol. However, probably because of the Westernization of Japanese dietary habits, the improvement in the average build is q...

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“…The low rates of death (4%) and heart transplantation (5%) over a mean of 2.2 years imply that contemporary heart failure therapy revolutionized the natural history of DCM. 2,3 In our previous study, RR (defined as 10% LVEF increase combined with a 10% decrease in the left ventricular dimension) occurred in 26% of DCM patients after an average follow-up of 32 months. 4 Fluctuations in LVEF are well recognized in DCM patients.…”

Section: Introductionmentioning

confidence: 92%

“…5 In the study by Choi and coworkers, 10% of the group who underwent RR had recurrence of heart failure symptoms combined with a decrement in their ejection fraction on a long-term followup. 3 The purpose of the current study was to examine the predictors and the prognostic implications of sustained, as compared to transient, LVEF improvement in DCM.…”

Section: Introductionmentioning

confidence: 99%

Predictors and Outcome of Sustained Improvement in Left Ventricular Function in Dilated Cardiomyopathy

Blechman

Arad

Nussbaum

et al. 2014

Clinical Cardiology

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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.

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Predictors of Left Ventricular Reverse Remodeling and Subsequent Outcome in Nonischemic Dilated Cardiomyopathy

Cited by 47 publications

References 17 publications

Prognostic Value of Pulmonary Hypertension in Ambulatory Patients With Non-Ischemic Dilated Cardiomyopathy

Prognostic Value of Pulmonary Hypertension in Ambulatory Patients With Non-Ischemic Dilated Cardiomyopathy

High Dose <i>β</i>-Blocker Therapy Triggers Additional Reverse Remodeling in Patients With Idiopathic Non-Ischemic Cardiomyopathy

Predictors and Outcome of Sustained Improvement in Left Ventricular Function in Dilated Cardiomyopathy

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