Prevalence and predictors of left ventricular reverse remodeling in patients with recent onset dilated cardiomyopathy on tailored medical therapy

Abstract

To observe the frequency and explore the predictors of left ventricular reverse remodeling(LVRR) in patients with recent onset dilated cardiomyopathy(RODCM) on tailored medical therapy. Patients hospitalized with RODCM in Heart Failure Care Unit in Fuwai Hospital from October 2008 to December 2013 were reviewed and followed up to December 2014 or death or cardiac transplantation.Patients were treated with tailored medical therapy. LVRR was defined as an at least 10% increase in left ventricular ejection fraction(LVEF) and to a final level of ≥ 50% and an at least 10 mm decrease in left ventricular end-diastolic diameter(LVEDD) and to a final level of ≤ 55 mm on repeat echocardiogram. Clinical, electrocardiogram and echocardiographic variables at baseline were evaluated to identify predictors of LVRR by multivariable logistic regression analysis. A total of 137 patients with RODCM were enrolled in this analysis. During a median follow-up period of 25 months(range 6 to 64 months) with repeat echocardiography, 46 patients(33.6%) were defined as LVRR, LVEF increased from(30.8±5.9) % at baseline to(59.7±4.6) % on follow-up(P<0.01) and LVEDD decreased from(63.8±4.0) mm at baseline to (49.6±3.5) mm on follow-up(P<0.01) in these patients. Multivariable logistic regression analysis showed that higher systolic blood pressure at presentation(per 10 mmHg(1 mm Hg=0.133 kPa) increase, OR=1.379, P<0.01), shorter QRS interval(≤ 100 ms vs. >100 ms, OR=2.959, P<0.01) and smaller LVEDD(per 5 mm increase, OR=0.684, P<0.01) at baseline were independent predictors of LVRR. On current tailored medical therapy, LVRR could be achieved in about one third of patients with RODCM. Patients with higher systolic blood pressure on admission, shorter QRS interval and smaller LVEDD at baseline are associated with a higher likelihood of occurrence of LVRR.