Myocardial Recovery in Dilated Cardiomyopathy with Goal Directed Medical Therapy

Abstract

Background Dilated cardiomyopathy (DCM) is a common cause of heart failure (HF). Goal Directed Medical Therapy (GDMT) for HF has been shown to improve mortality and morbidity but rate of myocardial recovery is not well known. Methods In this retrospective study, 325 patients with newly diagnosed systolic heart failure (LVEF 10% and maintained >6 months. At baseline, all patients underwent echocardiogram; additionally, 22% underwent cardiac MRI, 7% cardiopulmonary stress test and 14% right heart catherization. GDMT was initiated inpatient and titrated weekly the first month, biweekly for the second month and monthly thereafter in our HF clinic. At discharge, 25% of the patients were sent home with wearable cardioverter-defibrillator (WCD). Results Of the 325 patients, 148 patients (45.5%) had myocardial recovery. In the recovery group, average age was 55.0 years, 58.8% were males, 64.9% Caucasians and 30.0% African Americans. At baseline, average LVEF was 27.3% and NYHA class 2.3. Average time for myocardial recovery was four months post initiation of GDMT. At one-year follow-up, average LVEF was 48.6% and NYHA class 1.7. In the recovery group, 84.0% were on ACEI/ARB/ARNI, 95.3% BB, 59.5% MRA, 4.7% Hydralazine, 2.7% Nitrates and 13.4% on Digoxin. No malignant arrhythmias were noted in patients discharged with WCD. The 30-day HF readmission rate in the myocardial recovery group was Conclusion GDMT for HF is well established and with aggressive medication titration in newly diagnosed systolic HF due to DCM and NICM, myocardial recovery is possible with rates as high as 45.5% at one-year.