Incidence and prognosis implications of long term left ventricular reverse remodeling in patients with dilated cardiomyopathy

Ruíz-Zamora, Isabel; Rodríguez-Capitán, Jorge; Guerrero-Molina, Alicia; Morcillo‐Hidalgo, Luis; Rodríguez–Bailón, Isabel; Gómez‐Doblas, Juan José; Teresa–Galván, Eduardo de; García‐Pinilla, José Manuel

doi:10.1016/j.ijcard.2015.11.099

Cited by 13 publications

(12 citation statements)

References 30 publications

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“…Forty‐two studies fulfilled the search criteria (Supporting Information, Table ) 5,7–47 . Two of them evaluated exclusively AR, 46,47 and two other studies assessed AR together with RR 8,9 .…”

Section: Resultsmentioning

confidence: 99%

Prognostic value of reverse remodelling criteria in heart failure with reduced or mid‐range ejection fraction

et al. 2021

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Aims Reverse remodelling (RR) is the recovery from left ventricular (LV) dilatation and dysfunction. Many arbitrary criteria for RR have been proposed. We searched the criteria with the strongest prognostic yield for the hard endpoint of cardiovascular death. Methods and resultsWe performed a systematic literature search of diagnostic criteria for RR. We evaluated their prognostic significance in a cohort of 927 patients with LV ejection fraction (LVEF) < 50% undergoing two echocardiograms within 12 ± 2 months. These patients were followed for a median of 2.8 years (interquartile interval 1.3-4.9) after the second echocardiogram, recording 123 cardiovascular deaths. Two prognostic models were defined. Model 1 included age, LVEF, N-terminal pro-B-type natriuretic peptide, ischaemic aetiology, cardiac resynchronization therapy, estimated glomerular filtration rate, New York Heart Association, and LV end-systolic volume (LVESV) index, and Model 2 the validated Cardiac and Comorbid Conditions Heart Failure score. We identified 25 criteria for RR, the most used being LVESV reduction ≥15% (12 studies out of 42). In the whole cohort, two criteria proved particularly effective in risk reclassification over Model 1 and Model 2. These criteria were (i) LVEF increase >10 U and (ii) LVEF increase ≥1 category [severe (LVEF ≤ 30%), moderate (LVEF 31-40%), mild LV dysfunction (LVEF 41-55%), and normal LV function (LVEF ≥ 56%)]. The same two criteria yielded independent prognostic significance and improved risk reclassification even in patients with more severe systolic dysfunction, namely, those with LVEF < 40% or LVEF ≤ 35%. Furthermore, LVEF increase >10 U and LVEF increase ≥1 category displayed a greater prognostic value than LVESV reduction ≥15%, both in the whole cohort and in the subgroups with LVEF < 40% or LVEF ≤ 35%. For example, LVEF increase >10 U independently predicted cardiovascular death over Model 1 and LVESV reduction ≥15% (hazard ratio 0.40, 95% confidence interval 0.18-0.90, P = 0.026), while LVESV reduction ≥15% did not independently predict cardiovascular death (P = 0.112). Conclusions Left ventricular ejection fraction increase >10 U and LVEF increase ≥1 category are stronger predictors of cardiovascular death than the most commonly used criterion for RR, namely, LVESV reduction ≥15%.

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Section: Resultsmentioning

confidence: 99%

Prognostic value of reverse remodelling criteria in heart failure with reduced or mid‐range ejection fraction

et al. 2021

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“…The mean duration between the two examinations at 6 months (interquartile range [4][5][6][7][8][9][10][11]. Changes in body weight were very small.…”

Section: Resultsmentioning

confidence: 99%

“…Guideline‐based therapies, both drugs and devices, can reverse the detrimental alterations to the left ventricle, referred to as left ventricular reverse remodelling (LVRR). In contrast with LVR, LVRR has been associated with improved survival …”

Section: Introductionmentioning

confidence: 99%

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High body mass index is a predictor of left ventricular reverse remodelling in heart failure with reduced ejection fraction

et al. 2017

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AimsStructural and functional left ventricular alterations can occur in heart failure (HF), referred to as left ventricular reverse remodelling (LVRR). This study aimed to define novel predictors of LVRR besides well‐known effects of medical and device therapy.Methods and resultsFrom echographic database, we included 295 patients with both left ventricular ejection fraction (LVEF) ≤45% and indexed left ventricular end‐diastolic diameter ≥33 mm/m2 and who had at least two echocardiographic exams with a delay between 3 and 12 months. LVRR was defined as the combination of (i) normalization of LVEF (LVEF ≥50%) or increase in LVEF ≥10% and (ii) a decrease in indexed left ventricular end‐diastolic diameter ≥10%. Clinical follow‐up was also obtained. LVRR occurred in 53 (18%) patients. Patients in the LVRR group were more likely to present with de novo HF (75% vs. 42%), had lower LVEF and left ventricular end‐diastolic volumes at index examination, yet a higher body mass index (BMI) than non‐LVRR patients. Obesity was observed in 25% of LVRR patients vs. 14% in others. In multivariate analyses, BMI (per each 1 kg/m2 increase) emerged as a predictor of LVRR: odds ratio 1.10 (95% confidence interval 1.02–1.19) after adjustment to other predictors of LVRR. During a mean follow‐up of 37 months, 32% of patients had a major adverse cardiac event; de novo HF, age, and LVEF were associated with major adverse cardiac event.ConclusionsWe identified significant relationship between high BMI and LVRR. This intriguing novel finding deserves further study.

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“…After treatment initiation, the process of LVRR usually needs from 6 months to 2 years to take place [ 144 ]. LVRR and the time required to achieve it seem to be strongly related to the long-term prognosis of DCM patients [ 145 ]. Some important parameters shown to be affecting the prognosis of the disease and the likelihood of LVRR in the first stages of DCM, should be systematically assessed both at diagnosis and during follow-up.…”

Section: Prognostic Markers and Genotype Correlation: The Importance Of Long Term Follow-upmentioning

confidence: 99%

Dilated cardiomyopathy in the era of precision medicine: latest concepts and developments

2021

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Dilated cardiomyopathy (DCM) is an umbrella term entailing a wide variety of genetic and non-genetic etiologies, leading to left ventricular systolic dysfunction and dilatation, not explained by abnormal loading conditions or coronary artery disease. The clinical presentation can vary from asymptomatic to heart failure symptoms or sudden cardiac death (SCD) even in previously asymptomatic individuals. In the last 2 decades, there has been striking progress in the understanding of the complex genetic basis of DCM, with the discovery of additional genes and genotype-phenotype correlation studies. Rigorous clinical work-up of DCM patients, meticulous family screening, and the implementation of advanced imaging techniques pave the way for a more efficient and earlier diagnosis as well as more precise indications for implantable cardioverter defibrillator implantation and prevention of SCD. In the era of precision medicine, genotype-directed therapies have started to emerge. In this review, we focus on updates of the genetic background of DCM, characteristic phenotypes caused by recently described pathogenic variants, specific indications for prevention of SCD in those individuals and genotype-directed treatments under development. Finally, the latest developments in distinguishing athletic heart syndrome from subclinical DCM are described.

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Incidence and prognosis implications of long term left ventricular reverse remodeling in patients with dilated cardiomyopathy

Cited by 13 publications

References 30 publications

Prognostic value of reverse remodelling criteria in heart failure with reduced or mid‐range ejection fraction

Prognostic value of reverse remodelling criteria in heart failure with reduced or mid‐range ejection fraction

High body mass index is a predictor of left ventricular reverse remodelling in heart failure with reduced ejection fraction

Dilated cardiomyopathy in the era of precision medicine: latest concepts and developments

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