Time course of left ventricular reverse remodeling in response to pharmacotherapy: clinical implication for heart failure prognosis in patients with idiopathic dilated cardiomyopathy

Abstract

The present study aimed to identify the clinical significance of differences in detection timings of left ventricular reverse remodeling (LVRR) on heart failure (HF) prognosis in patients with idiopathic dilated cardiomyopathy (IDCM). We investigated 207 patients with IDCM who underwent pharmacotherapeutic treatment. LVRR was defined as improvements in both LV ejection fraction ≥10 % and indexed LV end-diastolic dimension (LVEDDi) ≥10 %. Patients were stratified into 3 groups by LVRR timing: patients with LVRR <24 months (Early LVRR), those with LVRR ≥24 months (Delayed LVRR), and those without LVRR during the entire follow-up period (No LVRR). The major endpoint was first detection of composite event including readmission for decompensated HF, major ventricular arrhythmias, or all-cause mortality. LVRR was recognized in 108 patients (52 %): Early LVRR in 83 (40 %), Delayed LVRR in 25 (12 %), and No LVRR in 99 (48 %). The survival rate for the major endpoint was significantly higher for Delayed LVRR than for No LVRR (P = 0.001); there was no significant difference between Early and Delayed LVRR. Among patients without LVRR <24 months (Delayed + No LVRR), receiver operating characteristic curve analysis showed that the area under the curve for improvement in LVEDDi during the first 6 months for predicting subsequent LVRR (Delayed LVRR) [0.822 (95 % confidence interval, 0.740-0.916; P = 0.038)] was greater than that for improvement in LVEF. In conclusion, LVRR was a favorable prognostic indicator in patients with IDCM irrespective of its detection timing. Reduced LVEDDi during the first 6 months was predictive for subsequent LVRR in the later phase.

Prognostic significance of beta-blocker up-titration in conjunction with cardiac resynchronization therapy in heart failure management

“…BB was up-titrated toward the target dose in Japan [10] (carvedilol 20 mg/day, bisoprolol 5 mg/ day), and the up-titration was halted in the following circumstances: worsened HF status including peripheral hypoperfusion, systolic blood pressure of <90 mmHg, heart rate (HR) of <60 beats/min, eruption of grade II or III atrioventricular block, and subjective symptoms such as dizziness. Daily doses of BB were demonstrated as equivalents of carvedilol (carvedilol-equivalent doses: metoprolol, 2; bisoprolol, 0.2) [11][12][13].…”

Beneficial Effect of Left Ventricular Remodeling after Early Change of Sacubitril/Valsartan in Patients with Nonischemic Dilated Cardiomyopathy

“…Additionally, some of patients in group S/L were not responsive to previous ACEI/ARB treatment and showed dyspnea levels above New York Heart Association (NYHA) class II despite using ACEI/ARB and other HF medications for a long time. In clinical practice, if patients with nonischemic DCM do not show early improvement in LV function after initiation of HF medication (<6 months), the improvement rates of LV reverse remodeling and LVEF generally decrease, which is associated with poor prognosis [ 15 ]. Thus, a relatively high proportion of patients who did not respond to ACEI/ARB and BB for long periods in group S/L might affect the outcomes.…”

“…Patients who were younger than 18 years, those who had combined significant valvular heart disease, or those who had undergone cardiac resynchronization therapy were excluded. Responders to HF medication were defined as patients with an increase in LVEF from ≥10% to a final value of ≥35% according to previous studies [ 10 , 15 ]. The present study was carried out according to the principles of the Declaration of Helsinki and was approved by the Clinical Research Institute of Mediplex Sejong Hospital (approved on 9 June 2020; IRB No.…”

Temporal change of myocardial tissue character is associated with left ventricular reverse remodeling in patients with dilated cardiomyopathy: A cardiovascular magnetic resonance study

“…LVRR was defined as an increase in LVEF from !10% to a final value of !35% together with a decrease in LV end-diastolic diameter index (LVDDi) !10% at follow-up echocardiography [7,8]. Cardiac events after follow-up CMR examinations were defined as cardiac death, sudden death, implantation of ventricular assist device, readmission for heart failure exacerbation and major ventricular arrhythmias.…”

“…Simultaneously, more patients with DCM have achieved left ventricular reverse remodeling (LVRR), defined as improvement in LV contraction and decrease in LV volume. Furthermore, LVRR is related to favorable prognosis [5][6][7][8][9]. However, it has been difficult to predict who can achieve LVRR by GDMT.…”