Relapse in patients with non-ischemic dilated cardiomyopathy and improved ejection fraction managed with medical therapy.

BACKGROUND

Relapse is an important problem in nonischemic dilated cardiomyopathy (DCM) patients with improved left ventricular ejection fraction (LVEF). This study aimed to determine the long-term outcomes of patients with non-ischemic dilated cardiomyopathy and improved ejection fraction and analyse the risk of relapse in patients being managed with medical therapy.

METHODS

This was a single-centre, retrospective, observational study of all adult patients with non-ischemic DCM enrolled in a cohort. Patients with improved LVEF defined as LVEF <40% at baseline who showed improvement of LVEF to a level ≥40% with an absolute increase in LVEF of ≥10% while on medical therapy were included and followed-up till end of study period.

RESULTS

Of the 548 patients in the non-ischemic DCM group, 131 (23.9%) had an improved LVEF. Of these, 72 (55%) patients had sustained improvement, while 59 (45%) relapsed during follow-up. In the relapsed group, 7 (11.9%) patients had discontinued drug therapy. Relapse occurred at a median duration of 57 months (range 8-224 months) after improvement of LVEF. Of the total patients who had improved LVEF, 3.8% relapsed by 1 year, 23.7% by 5 years and 37.4% by 10 years.

CONCLUSION

In this non-ischemic DCM cohort 23.9% patients improved their LVEF. Of these, 45% relapsed. Risk of relapse persists over long-term with nearly 50% patients relapsing more than 5 years after their improvement in LVEF. Diabetes mellitus and higher left ventricular internal diameter in diastole at improvement were independent predictors of relapse.