Abstract 13067: Early vs. Late Reverse Ventricular Remodeling in Patients with Cardiomyopathy After Acute Decompensation
Background: Predictors of left ventricular reverse remodeling (LVRR) and differences in the time taken to achieve LVRR remain unclear.
Methods: We consecutively registered 227 patients with severe cardiomyopathy admitted with post-acute decompensation heart failure (HF). Follow-up echocardiographic data were available for 132 patients (58.1%). Patients were followed for a median of 774 days (IQ; 447.5, 1080). LVRR was defined as a decrease in indexed left ventricular systolic dimension of at least 15% and a 25% improvement in left ventricular ejection fraction (LVEF) at outpatient check-up compared with measurements at discharge. LVRR accomplishment within 400 days was defined as early LVRR. The remaining LVRR patients were classified as late LVRR.
Results: The patients had a mean age of 63.86 ± 15.12 years; 80.3% were male, and 72.0% had a non-ischemic etiology. LVRR was observed in 51 patients (38.6%). Baseline predictors for LVRR were age (OR, 1.04; p=0.068), history of previous hospitalization for HF (OR, 2.37; p=0.069), sBP <100 mmHg (OR, 3.24; p=0.028), and hemoglobin concentration at discharge (OR, 0.82; p=0.086). Overall, there were 53 events of death or HF hospitalization. The number of composite events in the LVRR and non-LVRR groups was 12 (23.5%) and 53 (50.6%), respectively (log-rank test, p < 0.001). LVRR was a significant predictor of favorable prognosis (HR, 2.85; p = 0.007). Notably, 39 (78.4%) patients qualified for early LVRR. The early-response group was significantly associated with better prognosis compared with the late-LVRR group (log-rank test, p = 0.004). Among assessed variables, sBP <100mmHg at discharge was a significant predictor of late-LVRR (OR, 0.04; p=0.008).
Conclusion: Prognosis was improved in patients who achieved LVRR. Early response to treatment was a major advantage in terms of long-term prognosis. Higher sBP was a predictor not only for all-LVRR but also early-LVRR against late-LVRR.
- © 2012 by American Heart Association, Inc.