Diastolic functional class improvement is associated with more favorable outcomes in patients with acute nonischemic cardiomyopathy

Abstract

Background: Patients with recent onset non-ischemic cardiomyopathy (ROCM) have variable clinical course related to left ventricular (LV) systolic recovery. It is unknown if temporal changes in diastolic function (DF) class can predict outcomes independent of LV systolic functional recovery in these patients. Methods: In the multicenter IMAC-2 (Intervention in Myocarditis and Acute Cardiomyopathy) study, there were 147 patients with ROCM (ejection fraction (EF) ≤40%, <6 months of symptoms) consistent with idiopathic cardiomyopathy or myocarditis who were prospectively studied by echocardiography. Systolic function was measured by biplane Simpson's rule EF and DF by mitral inflow velocities and mitral annular tissue Doppler at presentation and 6-month follow-up. Cox proportional hazards modeling was used to risk-adjust comparisons for the combined endpoint of death, transplantation and heart failure hospitalization. Results: Of 147 patients, (mean age 46±14 yrs, 40% female), baseline LVEF was 23±8%. At 6-months, LVEF improved to 41±12%, with 68% increasing by at least 10% EF units. DF improved in 55%, was unchanged in 27% and worsened in 13%. Over a mean follow-up of 1.8±1.2 yrs, there were 3 deaths, 4 transplants and 11 heart failure hospitalizations. LVEF at 6 months (HR=0.95, 95% CI 0.92-0.99,p=0.03) and improvement or maintaining DF class at 6-months were independently associated with lower likelihood for the combined end-point (HR=0.26, 95% CI 0.09-0.73, p=0.01). ![Figure][1] 6-Month Diastolic function and outcomes Conclusion: In patients with ROCM, improvement in or maintaining DF class was associated with more favorable outcomes, independent of LV systolic functional recovery. The association of DF with clinical outcomes suggest DF as a potential important prognostic marker in these patients. [1]: pending:yes