title: Diastolic function improvement is associated with favourable outcomes in patients with acute non-ischaemic cardiomyopathy: insights from the multicentre IMAC-2 trial.
abstract: OBJECTIVE
  Patients with recent onset non-ischaemic cardiomyopathy have a variable clinical course with respect to recovery of left ventricular ejection fraction (LVEF). The aim of this study was to understand whether temporal changes in diastolic function (DF) are associated with clinical outcomes independent of LVEF recovery.
  
  
  RESULTS
  The Intervention in Myocarditis and Acute Cardiomyopathy (IMAC)-2 study was a prospective, multicentre trial investigating myocardial recovery in subjects with symptoms onset of <6 months and LVEF ≤40% of non-ischaemic dilated cardiomyopathy related to idiopathic cardiomyopathy or myocarditis. LVEF and DF were measured at presentation and at 6-month follow-up. Of 147 patients (mean age 46 ± 14 years, 40% female), baseline LVEF was 23 ± 8%. At 6 months, LVEF improved to 41 ± 12%, with 71% increasing by at least 10% ejection fraction units. DF improved in 58%, was unchanged in 28%, and worsened in 14%. Over a mean follow-up of 1.8 ± 1.2 years, there were 18 events: 11 heart failure (HF) hospitalizations, 3 deaths, and 4 heart transplants. LVEF (HR = 0.94, 95% CI 0.91-0.98, P = 0.002) and DF improvements at 6 months (HR = 0.32, 95% CI 0.11-0.92, P = 0.03) were independently associated with lower likelihood for the combined end point of death, transplantation, and HF hospitalization. Diastolic functional improvement at 6-month follow-up was as prognostically important as LVEF recovery for these patients, and provided incremental prognostic value to the risk stratification (X(2) increased from 12.6 to 18, P = 0.02).
  
  
  CONCLUSIONS
  In patients with recent onset non-ischaemic cardiomyopathy, DF recovery was associated with favourable outcomes independent of LVEF improvement, adding incremental prognostic value to these patients.
authors.affiliation: Heart & Vascular Institute-UPMC, UPMC/University of Pittsburgh, 200 Lothrop Street, Scaife Hall, S-558, Pittsburgh, PA, USA cavalcantejl@upmc.edu.
authors.forename: João L
authors.initials: JL
authors.lastname: Cavalcante
authors.affiliation: Heart & Vascular Institute-UPMC, UPMC/University of Pittsburgh, 200 Lothrop Street, Scaife Hall, S-558, Pittsburgh, PA, USA.
authors.forename: Josef
authors.initials: J
authors.lastname: Marek
authors.affiliation: Jewish General Hospital/McGill University, Montreal, Canada.
authors.forename: Richard
authors.initials: R
authors.lastname: Sheppard
authors.affiliation: Cleveland Clinic Foundation, Cleveland, OH, USA.
authors.forename: Randall C
authors.initials: RC
authors.lastname: Starling
authors.affiliation: Jefferson Medical College of Thomas Jefferson University, Philadelphia, PA, USA.
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Mather
authors.affiliation: University of Rochester Medical Center, Rochester, NY, USA.
authors.forename: Jeffrey D
authors.initials: JD
authors.lastname: Alexis
authors.affiliation: Mount Sinai Hospital, New York, NY, USA.
authors.forename: Jagat
authors.initials: J
authors.lastname: Narula
authors.affiliation: Heart & Vascular Institute-UPMC, UPMC/University of Pittsburgh, 200 Lothrop Street, Scaife Hall, S-558, Pittsburgh, PA, USA.
authors.forename: Dennis M
authors.initials: DM
authors.lastname: McNamara
authors.affiliation: Heart & Vascular Institute-UPMC, UPMC/University of Pittsburgh, 200 Lothrop Street, Scaife Hall, S-558, Pittsburgh, PA, USA.
authors.forename: John
authors.initials: J
authors.lastname: Gorcsan
mesh_terms: D000208:Acute Disease; D000328:Adult; D002311:Cardiomyopathy, Dilated / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D003971:Diastole / Q000502:physiology; D004452:Echocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D013318:Stroke Volume / Q000502:physiology*; D013997:Time Factors; D020257:Ventricular Remodeling / Q000502:physiology*
keywords: diastolic function changes; outcomes assessment; recent non-ischaemic cardiomyopathy