Prevalence, predictors and prognosis of ventricular reverse remodeling in idiopathic dilated cardiomyopathy

Amorim, Sandra; Campelo, Manuel; Martins, Elisabete; Moura, Brenda; Sousa, Alexandra; Pinho, Teresa; Silva-Cardoso, José; Maciel, Maria Júlia

doi:10.1016/j.repc.2015.11.014

Cited by 23 publications

(19 citation statements)

References 25 publications

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“…However, only 38 patients had CMR and of these, over 50% had LGE, which is higher than conventional estimates, suggesting that their criteria for identification of mid-wall fibrosis (as opposed to all forms of LGE) were inadequate. 9 Notably, and in line with other studies, baseline LVEF did not predict LVRR.…”

Section: Predictors Of LV Remodelingsupporting

confidence: 87%

“…In a Portuguese study of 113 DCM patients followed for 7 years, LVRR (defined as absolute LVEF increase of 10% and decrease in LV diastolic diameter) occurred in approximately one-third of patients. 9 On multivariable analysis, only ACEi use was associated with LVRR. CMR-LGE was not a predictor on univariable analysis.…”

Section: Predictors Of LV Remodelingmentioning

confidence: 99%

“…However, there is no universal definition of improvement in LV function, with studies reporting either absolute change in left ventricular ejection fraction (LVEF) 3,5,8,9,11,12 (from 5% to 20%) or improvement above a threshold level, often set at LVEF 50%, 6,8,13 with some studies reporting the additional metric of reduction in LV dilation. 5,6,8 However, an LVEF-based definition of recovery may also be inadequate as subtle dysfunction in cardiac strain or energetics can remain, even in the presence of apparently normalized LVEF.…”

Section: Variable Definitions For Reverse Remodeling Limit Our Undersmentioning

confidence: 99%

“…Spontaneous improvement in symptoms and potentially complete recovery of left ventricular (LV) function is reported in approximately 25–70% of DCM patients. 3–10 In this review article, we discuss the capacity for recovery in DCM, the prognostic implications of this recovery, and potential predictors for myocardial remodeling. …”

Section: Introductionmentioning

confidence: 99%

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Myocardial remodelling and recovery in dilated cardiomyopathy

Tayal

Prasad

2017

JRSM Cardiovascular Disease

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Myocardial reverse remodeling has been reported to occur in 25–70% of patients with dilated cardiomyopathy. It is not yet fully understood whether remodeling represents disease remission or cure and which hearts retain this capacity to recover. In this review article we discuss the capacity for recovery in DCM, the prognostic implications of this recovery and potential clinical and imaging predictors for myocardial remodeling.

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Section: Predictors Of LV Remodelingsupporting

confidence: 87%

Section: Predictors Of LV Remodelingmentioning

confidence: 99%

Section: Variable Definitions For Reverse Remodeling Limit Our Undersmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Myocardial remodelling and recovery in dilated cardiomyopathy

Tayal

Prasad

2017

JRSM Cardiovascular Disease

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“…In this study, treatment with ACEIs and betablockers was the strongest predictor of LVEF recovery. These drugs have shown a favorable effect on patient survival and decreased morbidity [27,28] in patients with HFrEF, they also improve cardiac remodeling factors [29], which may contribute to explaining the LVEF recovery process.…”

Section: Discussionmentioning

confidence: 99%

Heart failure with recovered ejection fraction: Clinical characteristics, determinants and prognosis. CARDIOCHUS-CHOP registry

et al. 2018

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

et al. 2021

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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.

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Prevalence, predictors and prognosis of ventricular reverse remodeling in idiopathic dilated cardiomyopathy

Abstract: LVRR occurred in one third of IDCM patients, especially in those with mild hypertension and with less advanced disease, who may have benefited from maximal drug titration.

Cited by 23 publications

References 25 publications

Myocardial remodelling and recovery in dilated cardiomyopathy

Myocardial remodelling and recovery in dilated cardiomyopathy

Heart failure with recovered ejection fraction: Clinical characteristics, determinants and prognosis. CARDIOCHUS-CHOP registry

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

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