title: Clinical and demographic predictors of outcomes in recent onset dilated cardiomyopathy: results of the IMAC (Intervention in Myocarditis and Acute Cardiomyopathy)-2 study.
abstract: OBJECTIVE
  We sought to determine clinical and demographic predictors of recovery of left ventricular function for subjects with recent onset cardiomyopathy (ROCM).
  
  
  BACKGROUND
  Although ROCM is a frequent reason for consultation and transplantation referral, its prognosis and natural history on contemporary therapy are unknown.
  
  
  METHODS
  In the multicenter IMAC (Intervention in Myocarditis and Acute Cardiomyopathy)-2 study, subjects with a left ventricular ejection fraction (LVEF) of ≤0.40, fewer than 6 months of symptom duration, and an evaluation consistent with idiopathic dilated cardiomyopathy or myocarditis were enrolled. LVEF was reassessed at 6 months, and subjects were followed up for 4 years. LVEF and event-free survival were compared by race, sex, and clinical phenotype.
  
  
  RESULTS
  The cohort of 373 persons was 38% female and 21% black, with a mean age of 45 ± 14 years. At entry, 91% were receiving angiotensin-converting enzyme inhibitors or angiotensin receptor blockers and 82% were receiving beta-blockers, which increased to 92% and 94% at 6 months. LVEF was 0.24 ± 0.08 at entry and 0.40 ± 0.12 at 6 months (mean increase: 17 ± 13 ejection fraction units). Transplant-free survival at 1, 2, and 4 years was 94%, 92%, and 88%, respectively; survival free of heart failure hospitalization was 88%, 82%, and 78%, respectively. In analyses adjusted for sex, baseline LVEF, and blood pressure, LVEF at 6 months was significantly lower in blacks than in nonblacks (p = 0.02). Left ventricular end-diastolic diameter at presentation was the strongest predictor of LVEF at 6 months (p < 0.0001).
  
  
  CONCLUSIONS
  Outcomes in ROCM are favorable but differ by race. Left ventricular end-diastolic diameter by transthoracic echo at presentation was most predictive of subsequent myocardial recovery. (Genetic Modulation of Left Ventricular Recovery in Recent Onset Cardiomyopathy; NCT00575211).
authors: Cardiovascular Institute, University of Pittsburgh Medical Center, 200 Lothrop Street, Pittsburgh, PA 15213, USA. mcnamaradm@upmc.edu
authors: Dennis M
authors: DM
authors: McNamara
authors: Randall C
authors: RC
authors: Starling
authors: Leslie T
authors: LT
authors: Cooper
authors: John P
authors: JP
authors: Boehmer
authors: Paul J
authors: PJ
authors: Mather
authors: Karen M
authors: KM
authors: Janosko
authors: John
authors: J
authors: Gorcsan
authors: Kevin E
authors: KE
authors: Kip
authors: G William
authors: GW
authors: Dec
mesh_terms: D000328:Adult; D001741:Black or African American; D002311:Cardiomyopathy, Dilated / Q000208:ethnology*; D003971:Diastole; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011446:Prospective Studies; D020127:Recovery of Function; D012737:Sex Factors; D014481:United States / Q000453:epidemiology; D016277:Ventricular Function, Left