Frequency, prognosis and predictors of improvement of systolic left ventricular function in patients with ‘classical’ clinical diagnosis of idiopathic dilated cardiomyopathy

Abstract

Ž. In patients with dilated cardiomyopathy DCM of different aetiologies, a variable frequency of improvement in the left Ž . ventricular LV systolic function has been reported, while in patients with a 'classic' idiopathic DCM, the frequency of improvement is still under debate, and clinical and haemodynamic predictors of recovery of the LV function are needed. The aim of the present study was to determine the frequency of improvement in the LV systolic function in idiopathic DCM and to identify predictors of reversibility of the impaired LV contractility. A sample of 98 consecutive patients with idiopathic DCM was retrospectively evaluated. Echocardiographic and Doppler measurements were directly taken from the routine echo-Ž . report. LV systolic function was assessed semiquantitatively using a score index SFSI . According to the improvement in the LV systolic function, the patients were divided into group 1 patients with improvement, and group 2 patients without Ž . improvement. During a follow-up of at least 12 months, 19 patients 19% showed an improvement, with a significant increase Ž . Ž . in the mean SFSI; all these group 1 patients survived without heart transplant; in group 2, 18 patients 23% died and 3 4% Ž . received a heart transplant. Patients in group 1 had a significantly shorter duration of symptoms Ps 0.0045 , a younger age Ž . Ž . Ž . Ž . Ps 0.006 , a shorter DtE Ps 0.04 , a lower SFSI P-0.01 , a worse NYHA class P-0.001 and more frequently had a Ž . history of hypertension P-0.0001 . The same variables were significant predictors of improvement at the univariate analysis.Ž . At the multivariate logistic regression analysis, a shorter duration of symptoms Ps 0.02 , a history of hypertension Ž . Ž . Ps 0.003 , and a worse NYHA class Ps 0.01 were independent predictors of improvement. A relatively large percentage of patients with an idiopathic DCM will have a marked improvement in the LV systolic function. This is more likely to happen in the presence of a short duration of symptoms and a history of hypertension. After an improvement, the prognosis is excellent.

Delayed Enhancement Magnetic Resonance Imaging Is a Significant Prognostic Factor in Patients With Non-Ischemic Cardiomyopathy

“…It has been reported that the prevalence of spontaneous recovery in alcoholic cardiomyopathy is relatively high. 18 The pathologic studies shown that myocyte hypertrophy, fibrosis, and nuclear changes are significantly less frequent in alcoholic cardiomyopathy compared with idiopathic DCM. 19 However, in the present DE(+) group, cardiomyopathy without definite cause (namely, idiopathic) was the most frequent (90.5%), as expected.…”

Usefulness of Ventricular Longitudinal Contractility Assessed by Doppler Tissue Imaging in the Prediction of Reverse Remodeling in Patients with Severe Left Ventricular Systolic Dysfunction

“…[5][6][7][8] These observations have significant clinical impact on selecting patients for cardiac transplantation, because of the shortage of donor hearts. Baseline clinical variables associated with RR were shorter duration of symptoms, 5,6 a history of hypertension, 6-8 nonischemic cause of heart failure, 8 absence of diabetes mellitus, 7,8 carvedilol therapy, 7,8 higher serum sodium level, 5 and lower atrial pressure.…”

“…Although myocardial failure is generally considered an irreversible and progressive process characterized by left ventricular (LV) remodeling, some patients with marked LV dysfunction have been reported to show functional improvement or reverse remodeling (RR) after aggressive medical treatment, 1-4 leading many investigators to seek predictors of RR. [5][6][7][8] Echocardiographic indexes of ventricular systolic and diastolic function have become indispensable in evaluating patients with LV dysfunction, and have been tested as prognostic markers. [9][10][11][12][13] The recently introduced Doppler tissue imaging (DTI) technique provides unique information regarding regional myocardial function and ventricular longitudinal contractility (LC).…”

Arrhythmia Risk Stratification with Regard to Prophylactic Implantable Defibrillator Therapy in Patients with Dilated Cardiomyopathy

“…In addition, only patients with recent onset cardiomyopathy (≤ 9 months) were enrolled in CAT including an unknown number of patients with active myocarditis, since endomyocardial biopsies were not performed at the majority of participating centers. Significant improvements of LV dysfunction have been observed in approximately one third of patients, after the initial diagnosis of nonischemic dilated cardiomyopathy has been made [5][6][7][8][9][10]. Improvements of LV dysfunction have been observed even more frequently in patients with "recent-onset cardiomyopathy" [6][7][8].…”

“…Significant improvements of LV dysfunction have been observed in approximately one third of patients, after the initial diagnosis of nonischemic dilated cardiomyopathy has been made [5][6][7][8][9][10]. Improvements of LV dysfunction have been observed even more frequently in patients with "recent-onset cardiomyopathy" [6][7][8]. This may be explained by a high prevalence of "healing" myocarditis in these patients [6,10].…”