Abstract 13738: Prevalence and Clinical Impact of Normalization of Left Ventricular Ejection Fraction After Optimal Pharmacotherapy in Patients With Nonischemic Dilated Cardiomyopathy
Background: Some patients demonstrate marked response to optimal pharmacotherapy (OPT) and cardiac resynchronization therapy (CRT), as evidenced by improvement in left ventricular ejection fraction (LVEF) to normal range. However the clinical characteristics of such patients have not been clarified.
Methods: Of 254 consecutive patients diagnosed in 1996-2010 with nonischemic dilated cardiomyopathy (NIDCM), excluding patients with reversible CM such as tachycardia- or endocrine-induced, fatalities, and introduced CRT, those for whom clinical data for the first 3 years were not available were not enrolled. The remaining 203 patients with OPT were serially evaluated by echocardiography for 3 years. ‘‘Normalization’’ was defined as an increase in LVEF to ≥55%, together with a decrease in LV end-diastolic dimension to ≤55mm.
Results: During the study period, normalization was achieved in 67 (33%) patients. Kaplan-Meier analysis demonstrated that normalized patients had a significantly better prognosis for cardiac events including cardiovascular deaths, readmission for HF, and detection of major ventricular arrhythmia compared with those not normalized (P<0.001; Figure A). In multivariate logistic regression analysis moderate to severe mitral regurgitation (Odds ratio [OR] 0.2, 95% confidence interval [CI] 0.0-0.9, P<0.05), higher hemoglobin A1c (OR 1.5, 95% CI 1.0-2.2, P<0.05), lower plasma B-type natriuretic peptide (OR 0.9, 95% CI 0.9-1.0, P<0.05) and acute heart failure (AHF) episode (OR 3.1, 95% CI 1.3-7.4, P<0.001) were independent predictors at baseline of subsequent normalization. Early normalization (within 6 months) was recognized more in patients hospitalized with AHF episode than those without (P<0.05, Figure B).
Conclusions: Normalization of LVEF in NIDCM is occasionally seen after OPT, leading to favorable prognosis. Normalization is observed more often and earlier in patients with a preceding AHF episode than in those without.
- © 2013 by American Heart Association, Inc.