Recovery of normal ventricular function in patients with dilated cardiomyopathy: predictors of an increasingly prevalent clinical event.
BACKGROUND
This investigation was designed to identify clinical variables associated with recovery of normal ventricular function in patients with dilated cardiomyopathy treated with medical therapy. Recovery of normal ventricular function with medical treatment of patients with dilated cardiomyopathy is observed with increasing frequency. However, the clinical variables associated with such dramatic improvement of ventricular performance are poorly defined.


METHODS
Fifty-three patients with dilated cardiomyopathy and reduced ejection fractions who achieved an increase in ejection fraction to > or = 40% with medical therapy were identified during follow-up in a dedicated heart failure clinic. A cohort of patients frequency-matched on baseline ejection fraction who did not recover ventricular systolic function to this magnitude constituted the control group. Clinical variables characterizing the 2 groups were compared by univariable analysis. Variables that significantly differed between the 2 groups were entered in a stepwise logistic regression analysis to identify factors independently associated with recovery of ejection fraction to > or = 40%.


RESULTS
In the final logistic regression model, QRS duration, sex, etiology of cardiomyopathy, diabetes, and systolic blood pressure were significantly associated with improvement of ejection fraction to > or = 40%.


CONCLUSIONS
Five clinical variables that are independently associated with improvement of left ventricular ejection fraction to normal or near-normal values with medical therapy alone were identified by this modeling process. These variables may be used to discriminate between patients in whom ventricular function will normalize with medical therapy alone and those who will require more aggressive pharmacologic or device therapy.
Binkley
Philip F
PF
The Division of Cardiovascular Medicine and the Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University, Columbus, OH 43210-1282, USA. binkley-1@medctr.osu.edu
Lesinski
Amanda
A
Ferguson
Jeanette Pohorence
JP
Hatton
Patricia S
PS
Yamokoski
Laura
L
Hardikar
Sheetal
S
Cooke
Glen E
GE
Leier
Carl V
CV
D000328:Adult; D000367:Age Factors; D000704:Analysis of Variance; D002311:Cardiomyopathy, Dilated / Q000175:diagnosis* / Q000188:drug therapy* / Q000401:mortality; D002316:Cardiotonic Agents / Q000627:therapeutic use*; D016022:Case-Control Studies; D015331:Cohort Studies; D005260:Female; D006334:Heart Function Tests; D006439:Hemodynamics; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D012372:ROC Curve; D020127:Recovery of Function; D018570:Risk Assessment; D012720:Severity of Illness Index; D012737:Sex Factors; D013318:Stroke Volume / Q000502:physiology*; D015996:Survival Rate; D016896:Treatment Outcome; D016277:Ventricular Function, Left / Q000502:physiology*
D002316:Cardiotonic Agents