Recovery of normal ventricular function in patients with dilated cardiomyopathy: Predictors of an increasingly prevalent clinical event

Binkley, Philip F.; Lesinski, Amanda; Ferguson, Jeanette Pohorence; Hatton, Patricia S.; Yamokoski, Laura; Hardikar, Sheetal; Cooke, Glen E.; Leier, Carl V.

doi:10.1016/j.ahj.2007.08.010

Cited by 57 publications

(37 citation statements)

References 25 publications

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“…Our study differs from all the previous studies that have unequivocally stated that higher systolic blood pressure is 18 This, along with optimal medical management, may also be the reason behind remarkable improvement in LVEF in the recovered group. We have also studied right ventricular ejection fraction as a predictor of recovery of LVEF in patients with nonischemic DC and conclude that baseline right ventricular ejection fraction is not associated with recovery of LVEF in this cohort.…”

contrasting

confidence: 83%

Frequency of Recovery and Relapse in Patients With Nonischemic Dilated Cardiomyopathy on Guideline-Directed Medical Therapy

Gupta¹,

Goyal²,

Bahl³

2014

The American Journal of Cardiology

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contrasting

confidence: 83%

Frequency of Recovery and Relapse in Patients With Nonischemic Dilated Cardiomyopathy on Guideline-Directed Medical Therapy

Gupta¹,

Goyal²,

Bahl³

2014

The American Journal of Cardiology

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“…I read with interest the paper by McNamara et al (1), which supports the findings of our previous report of a logistic model that identifies factors associated with restoration of normal ventricular function in this patient population (2). As we noted in that paper, which indeed references the marked improvement in left ventricular function observed in the placebo group of the IMAC (Intervention in Myocarditis and Acute Cardiomyopathy) trial, we have entered a new era in the natural history of dilated cardiomyopathy in which restoration of normal ventricular function may be anticipated in a significant number of patients.…”

supporting

confidence: 81%

“…We certainly agree that several of the same factors appear to predict recovery in both the IMAC2 (Intervention in Myocarditis and Acute Cardiomyopathy 2) trial (1) and the cohort reported by Dr. Binkley and his colleagues (2). Indeed, consistent with the Ohio State report, in unpublished data from IMAC2, subjects with a left bundle branch block (LBBB) at presentation had a significantly lower left ventricular ejection fraction (LVEF) at 6 months (with LBBB, mean LVEF: 0.38 Ϯ 0.12; no LBBB: 0.41 Ϯ 0.12, p ϭ 0.04) and a trend toward less improvement in LVEF (with LBBB, change in LVEF from entry to 6 months: 0.14 Ϯ 0.14; no LBBB: 0.18 Ϯ 0.12, p ϭ 0.07).…”

Section: Replymentioning

confidence: 83%

A New Era in the Natural History of Dilated Cardiomyopathy

Binkley¹

2012

Journal of the American College of Cardiology

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A New Era in the Natural History of Dilated Cardiomyopathy I read with interest the paper by McNamara et al. (1), which supports the findings of our previous report of a logistic model that identifies factors associated with restoration of normal ventricular function in this patient population (2). As we noted in that paper, which indeed references the marked improvement in left ventricular function observed in the placebo group of the IMAC (Intervention in Myocarditis and Acute Cardiomyopathy) trial, we have entered a new era in the natural history of dilated cardiomyopathy in which restoration of normal ventricular function may be anticipated in a significant number of patients. This demands that we better identify those patients who are likely to recover normal ventricular function. Identification of those who have a high probability of recovery will allow early implementation of more aggressive therapies in those who are not likely to recover, and will point towards interventions that may augment the factors found to be associated with restoration of normal ventricular function.In particular, our report identified progressive increases in QRS duration, male gender, ischemic etiology of heart failure, and a history of diabetes mellitus as factors that decrease the probability of recovery. The probability of recovery increased with increasing systolic blood pressure at the time of initial diagnosis. Indeed, the report by McNamara et al. (1) is in agreement with 3 of these factors. They also find that female gender and increasing blood pressure are associated with recovery of ventricular function. Electrocardiographic QRS duration is known to correlate highly with ventricular chamber size, and therefore, it is not surprising that they find end-diastolic dimension to be a significant correlate with ventricular recovery. The cohort in their study did not strictly match that in our study, being focused on those with recent-onset cardiomyopathy. They specifically excluded patients with ischemic heart disease and diabetes, and therefore, our data provide insight into different etiologies of cardiomyopathy and the important comorbidity of diabetes. In addition, the average time to recovery of left ventricular function in our study was 40.3 Ϯ 4.7 months, providing total patient-years equivalent to that in the study by McNamara et al. (1), even though our cohort size was smaller. Our data show that recovery can be a slow process, and it would be interesting to see how the factors they identify influence recovery over longer periods of time.The recognition that patients with dilated cardiomyopathy can recover normal ventricular function raises important questions. Importantly, it is unknown whether return to normal ventricular function represents a true recovery from the cardiomyopathic process or is in fact a "remission" with persistence of normal function dependent on continued medical therapy. Indeed, we have reported a small series of patients who have "relapsed" with discontinuation of medical therapy (3). Should th...

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“…Contrary to our case, most of the studies showed that there is a significantly lower proportion of patients with left bundle branch block among those with LVEF improvement [7,8,9]. …”

Section: Discussioncontrasting

confidence: 52%

Left Ventricular Mechanical Reverse Remodelling Not Followed by Electrical Reverse Remodelling: A Case Report

Amorim¹,

García²,

Pinho³

et al. 2017

Cardiology

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Patients with severely depressed left ventricular ejection fractions (LVEFs) receive implantable cardioverter-defibrillators (ICDs) for the primary prevention of sudden death. However, in some patients, LVEFs may improve or even normalize over time, and these patients would no longer be qualified for ICD implantation based on the original criteria for which they have initially received an ICD. We report a patient with idiopathic dilated cardiomyopathy whose LVEF recovered to normal values after pharmacological therapy. Meanwhile, the patient had life-threatening ventricular fibrillation, aborted by the ICD. We reflect on the pathological features of left ventricular reverse remodelling and ventricular arrhythmogenesis, where the myocardial substrate appears to play an important role. Also, after LVEF improvement in a patient with a cardiac device, there is still a debate on whether we should perform a battery replacement.

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Recovery of normal ventricular function in patients with dilated cardiomyopathy: Predictors of an increasingly prevalent clinical event

Cited by 57 publications

References 25 publications

Frequency of Recovery and Relapse in Patients With Nonischemic Dilated Cardiomyopathy on Guideline-Directed Medical Therapy

Frequency of Recovery and Relapse in Patients With Nonischemic Dilated Cardiomyopathy on Guideline-Directed Medical Therapy

A New Era in the Natural History of Dilated Cardiomyopathy

Left Ventricular Mechanical Reverse Remodelling Not Followed by Electrical Reverse Remodelling: A Case Report

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