Predictors and outcome of sustained improvement in left ventricular function in dilated cardiomyopathy.

BACKGROUND

Improvement in the left ventricular ejection fraction (LVEF) may occur in patients with dilated cardiomyopathy (DCM).

HYPOTHESIS: There are different implications of persistent versus transient improvement in LVEF among DCM patients receiving contemporary therapy.

METHODS

We studied 188 patients with nonischemic DCM. Persistent improvement in LVEF (PIEF) was defined as LVEF increase by at least 10% compared to baseline, and found in 2 separate echo-Doppler exams performed at least 12 months apart. Increased LVEF in echo 2, which was not sustained in echo 3, was defined as transient improvement in LVEF (TIEF).

RESULTS

Over an average follow-up of 6.8 years, PIEF occurred in 61 (33%) patients, predicting a better long-term outcome (P < 0.001) in a combined end-point comprising death, heart transplantation, or the need for a ventricular assist device. The TIEF group had an intermediate course and were closer to nonimprovers (P = 0.003 vs PIEF). Multivariate logistic regression identified the following independent predictors of PIEF: shorter disease duration, pregnancy-associated disease, left ventricular hypertrophy, and baseline LVEF ≤ 25%. A score to predict PIEF assigned 1 point to each of the following: disease duration < 3 years and no familial cardiomyopathy; pregnancy-associated presentation; basal LVEF ≤ 25%; and left ventricular wall thickness ≥ 12. A score of ≥ 3 was present in 44% of the patients, reliably predicting PIEF in 91% (P = 0.01).

CONCLUSIONS

Persistent improvement in LVEF is associated with improved long-term prognosis. Baseline clinical parameters can be used to identify patients likely to demonstrate PIEF, thereby allowing tailored management in this population.