Abstract 14671: Myocardial Recovery After Initial Hospitalization for Heart Failure in Patients with Non-ischemic Cardiomyopathy
Background: Recovery of myocardial function has been demonstrated in outpatients with heart failure (HF) due to non-ischemic cardiomyopathy (NICM), but little is known about the high-risk population of patients after hospitalization for HF (HHF). We sought to examine the proportion of patients with NICM who experience myocardial recovery after initial HHF and examine outcomes associated with recovery status.
Methods: We identified patients with first HHF from NICM [reduced left ventricular ejection fraction (LVEF) ≤ 40%, not due to CAD, valvular disease, chemotherapy, infiltrative disease] using the Northwestern Medicine Enterprise Data Warehouse from January 1, 2000 to January 1, 2013. Myocardial recovery status was defined as: 1) myocardial recovery (absolute LVEF improvement ≥10%), 2) no change/ worsening of LVEF, and 3) no subsequent LVEF assessment. Multivariable-adjusted regression models were fitted to test the association between myocardial recovery status and all-cause mortality.
Results: There were 597 patients with NICM and first HHF that were analyzed (mean age 57±15 years, 42% women, 52% black). Over 3-18 months’ follow up, 166 (28%) had myocardial recovery (with improvement in LVEF from 24.3%±7.8% to 47.1% ±11.2%, p<0.001); 126 (21%) patients had no change in LVEF (25.8% ±7.5% to 25.9% ±9.0%, p=0.85); and 305 (51%) patients did not have subsequent LVEF assessment. Compared with patients with myocardial recovery, those with no change/worsening of LVEF had worse overall survival (HR=2.07; 95% CI 1.32-3.27; p<0.001). No subsequent LVEF assessment was also associated with higher mortality (HR=2.16; 95% CI 1.45-3.21; p<0.001). Results were similar for the composite endpoint of all-cause mortality, cardiac transplant or left ventricular assist device implantation.
Conclusion: Myocardial recovery is possible in patients with NICM after initial HHF and is associated with significantly improved event-free survival.
Author Disclosures: J.E. Wilcox: None. A.C. Andrei: None. S. Jonnalagadda: None. D.M. Lloyd-Jones: None.
This research has received full or partial funding support from the American Heart Association.
- © 2014 by American Heart Association, Inc.