Clinical and Demographic Predictors of Outcomes in Recent Onset Dilated Cardiomyopathy

McNamara, Dennis M.; Starling, Randall C.; Cooper, Leslie T.; Boehmer, John; Mather, Paul; Janosko, Karen; Gorcsan, John; Kip, Kevin E.; Dec, G. William

doi:10.1016/j.jacc.2011.05.033

Cited by 210 publications

(110 citation statements)

References 17 publications

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“…90 In adults, a recent study 91 showed that lack of β-blocker therapy was associated with a poor outcome. In adults, in recent-onset dilated cardiomyopathy in the Intervention in Myocarditis and Acute Cardiomyopathy II (IMAC-2) study, 92 routine use of angiotensin-converting enzyme inhibitors and β-blockers led to a transplantation-free survival of 88% and a survival free of heart failure hospitalization of 78%.…”

Section: Medical Therapymentioning

confidence: 99%

Diagnosis and Treatment of Myocarditis in Children in the Current Era

2014

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Section: Medical Therapymentioning

confidence: 99%

Diagnosis and Treatment of Myocarditis in Children in the Current Era

2014

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“…LVEF at presentation, length of hospitalization, previous MI, lateral wall motion abnormality at presentation, and peak troponin were shown to influence LVEF evolution post‐MI 13. Patients with recent diagnosis of NICM likewise showed a good recovery within 6 months after diagnosis 14. In our study including NICM as well as ICM, we could confirm these findings within 3 months, but beyond that, 33% of our patients even improved during prolongation period beyond 3 months after diagnosis, emphasizing the need for elaborate optimization of heart failure therapy.…”

Section: Discussionmentioning

confidence: 94%

Avoiding Untimely Implantable Cardioverter/Defibrillator Implantation by Intensified Heart Failure Therapy Optimization Supported by the Wearable Cardioverter/Defibrillator—The PROLONG Study

Duncker

König

Hohmann

et al. 2017

JAHA

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BackgroundOptimal timing of implantation of an implantable cardioverter/defibrillator (ICD) after newly diagnosed heart failure is unclear given that late reverse remodelling may occur. We aimed to analyze left ventricular ejection fraction (LVEF) after diagnosis of an LVEF ≤35% during optimization of heart failure drug therapy.Methods and ResultsOne hundred fifty‐six patients with newly diagnosed LVEF ≤35% receiving a wearable cardioverter/defibrillator (WCD) were analyzed. WCD was prescribed for 3 months until first re‐evaluation. Indications for prolongation of WCD wearing period instead of ICD implantation were: (1) LVEF at 3‐month visit 30% to 35%; (2) increase in LVEF of ≥5% compared to the last visit; and (3) nonoptimized heart failure medication. Mean LVEF was 24±7% at diagnosis and 39±11% at last follow‐up (mean, 12±10 months). Whereas 88 patients presented a primary preventive ICD indication (LVEF ≤35%) at 3‐month follow‐up, only 58 showed a persistent primary preventive ICD indication at last follow‐up. This delayed improvement in LVEF was related to nonischemic origin of cardiomyopathy, New York Heart Association functional class at baseline, heart rate, better LVEF after 3 months, and higher dosages of mineralocorticoid receptor antagonist. Twelve appropriate WCD shocks for ventricular tachycardia/ventricular fibrillation occurred in 11 patients. Two patients suffered from ventricular tachycardia/ventricular fibrillation beyond 3 months after diagnosis.ConclusionsA relevant proportion of patients with newly diagnosed heart failure shows recovery of LVEF >35% beyond 3 months after initiation of heart failure therapy. To avoid untimely ICD implantation, prolongation of WCD period should be considered in these patients to prevent sudden cardiac death while allowing left ventricular reverse remodeling during intensified drug therapy.

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“…Patients with recent-onset cardiomyopathy had generally favorable outcomes in the Intervention in Myocarditis and Acute Cardiomyopathy (IMAC)-2 study, with 88% transplant-free survival at 4 years. 19 A retrospective analysis of the Heartmate II bridge to transplant and destination therapy trials showed that patients with a shorter duration (<12 months) of HF had a higher probability of ventricular recovery. 20 Verbrugge et al 6 showed that the freedom of mortality or HF readmission was higher in patients with short duration of HF symptoms before the insertion of biventricular pacemaker, and this benefit was independent of left ventricular remodeling.…”

Section: Discussionmentioning

confidence: 99%

Duration of Heart Failure Is an Important Predictor of Outcomes After Mechanical Circulatory Support

Loyaga‐Rendon

Acharya

Pamboukian

et al. 2015

Circ: Heart Failure

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Background— Heart failure (HF) progression results in worsening functional capacity and end-organ compromise. HF may occur acutely or be associated with a chronic presentation. We hypothesized that the duration of HF affects outcomes after mechanical circulatory support. Methods and Results— A total of 10 730 patients registered in Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) who received primary implant of a mechanical circulatory support device were stratified according to the duration of HF symptoms: acute HF (AHF; ≤1 month), sub-AHF (1–12 months), and chronic HF (Cr-HF; ≥ 12 months). AHF patients were younger with a higher proportion of women and white and with a lower prevalence of peripheral vascular disease and history of prior cardiac surgeries. Sixty percent of AHF patients were INTERMACS profile 1 at the time of implantation versus 24% and 13.2% in the sub-AHF and Cr-HF groups, respectively ( P =0.0001). Patients with AHF had the highest utilization of biventricular support (14.4%). The estimated survival at 4 years was 58%, 51%, and 45% for the AHF, sub-AHF, and Cr-HF patients ( P =0.006). The proportion of patients with AHF who received heart transplantation at 1 year was 29% compared with 22.6% in the patients with Cr-HF. After adjustment for known risk factors of adverse outcome, patients with AHF have a better late phase prognosis compared with patients with Cr-HF (hazard ratio, 0.34; P =0.0003). Conclusions— The duration of HF before durable mechanical circulatory support implant is an important variable influencing outcome. Patients with AHF had improved survival at 4 years and higher rates of transplantation at 1 year despite higher acuity of presentation.

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Clinical and Demographic Predictors of Outcomes in Recent Onset Dilated Cardiomyopathy

Abstract: Outcomes in ROCM are favorable but differ by race. Left ventricular end-diastolic diameter by transthoracic echo at presentation was most predictive of subsequent myocardial recovery. (Genetic Modulation of Left Ventricular Recovery in Recent Onset Cardiomyopathy; NCT00575211).

Cited by 210 publications

References 17 publications

Diagnosis and Treatment of Myocarditis in Children in the Current Era

Diagnosis and Treatment of Myocarditis in Children in the Current Era

Avoiding Untimely Implantable Cardioverter/Defibrillator Implantation by Intensified Heart Failure Therapy Optimization Supported by the Wearable Cardioverter/Defibrillator—The PROLONG Study

Duration of Heart Failure Is an Important Predictor of Outcomes After Mechanical Circulatory Support

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