Comparative study of the timing of left ventricular reverse remodeling on prognosis in patients with nonischemic dilated cardiomyopathy

Abstract

Purpose: Although identification of left ventricular reverse remodeling (LVRR) has been demonstrated to have prognostic value for the stratification of long-term risk in cardiac patients, no studies have investigated the clinical significance of differences in the timing of LVRR detection to predict prognosis in patients with nonischemic dilated cardiomyopathy (NIDCM). Methods: We reviewed the institutional heart failure (HF) database records of 307 consecutive patients diagnosed with NIDCM from 1996 to 2011.Of all patients, we included 261 patients (85%) whose clinical data (including serial echocardiography) for more than 2 years was available. LVRR was defined as an absolute increase in LV ejection fraction ≥10% to a final value of ≥35% accompanied by a decrease in LV end-diastolic dimension of ≤10%. Patients were followed-up until death due to any cause, such as cardiovascular death, readmission for HF, or detection of major ventricular arrhythmia. Results: During the study period, in patients receiving tailored medical therapy, LVRR was found in 123 patients (49%). LVRR was an independent predictor of cardiac events by Cox proportional hazard analysis (risk ratio, =0.266; 95% confidence interval, 0.140-0.472; p<0.001). LVRR was detected within 2 years (12±6 months) in 94 cases (38%, Early LVRR) and after 2 years (30±12 months) in 29 cases (11%, Delayed LVRR). Kaplan-Meier survival curves demonstrated that no significant differences between Early and Delayed LVRR (p=0.213 by log-rank test). However, prognosis was significantly worse in patients without LVRR compared with those in whom Early or Delayed LVRR (p<0.001) had been identified (Figure). ![Figure][1] Kaplan-Meier Analyses Conclusions: LVRR has an equivalent impact on long-term prognosis in patients with NIDCM irrespective of the timing of the morphometric improvement. [1]: pending:yes