Prevalence, Predictors and Prognostic Value of Left Ventricular Reverse Remodeling and Relapse in Patients Hospitalized with Dilated Cardiomyopathy with Long-term Echocardiographic Follow-up

Abstract

Objectives to investigate prevalence, predictors, prognostic value of left ventricular reverse remodeling (LVRR) and relapse in patients hospitalized with dilated cardiomyopathy (DCM) from the initial center of heart failure (HF) in China. Methods Patients hospitalized in Heart Failure Care Unit, Fuwai Hospital from January 2009 to December 2013 with left ventricular ejection fraction (LVEF) 55 mm on admission were enrolled and followed up until June 2019 or death, heart transplantation, implantation of left ventricular assist device (LVAD). LVRR was defined as an absolute increase in LVEF ≥ 10% to a final level of ≥ 50% and an absolute decrease in LVEDD ≥ 5 mm to a final level of ≤ 55 mm during follow-up without symptoms of HF. Relapse was defined by a reduction in LVEF to 55 mm again after initial LVRR. Results A total of 448 patients were enrolled. After a median follow-up with repeat echocardiograms of 52 (24, 77) months, 126 patients (28.1%) have achieved LVRR, showing a significant increase in LVEF from 30.3±6.2 % at baseline to 56.1±4.6 % at initial LVRR, accompanied by a significant decrease in LVEDD from 65.5±6.9 mm to 50.9±3.1 mm (both P 6 months, odds ratio (OR) 2.433, 95% confidence interval (CI) 1.393-4.252, P = 0.002], systolic blood pressure at discharge (per 10 mmHg increase, OR 1.404, 95% CI 1.158-1.702, P = 0.001), LVEDD at baseline (per 5 mm increase, OR 0.665, 95% CI 0.569-0.778, P 13.7%, OR 2.268, 95% CI 1.231-4.179, P = 0.009) and NT-proBNP levels on admission (≤ 905.7 fmol/ml vs. > 905.7 fmol/ml, OR 2.189, 95% CI 1.175-4.080, P = 0.014) were significantly independent baseline predictors of LVRR. After a median clinical follow-up of 70 (43, 89) months, patients with LVRR showed a significantly lower occurrence of cardiovascular events than those without LVRR (4.8% vs. 30.9%, P Conclusions Based on current optimal medical and device therapy, about 30% patients with DCM in China can achieve LVRR which is associated with better prognosis. Some baseline parameters can predict the occurrence of LVRR. However, some patients, especially those discontinuing medications may suffer from relapse after initial LVRR.