title: Incidence and prognosis implications of long term left ventricular reverse remodeling in patients with dilated cardiomyopathy.
abstract: BACKGROUND
  Left ventricular reverse remodeling (LVRR) in dilated cardiomyopathy is poorly known within the context of current therapeutic approach. Our goal is to describe the present incidence of LVRR, the factors able to predict it and the long term prognosis of these patients.
  
  
  RESULTS
  We performed a retrospective analysis of a cohort or 387 consecutive outpatients. Mean follow-up was 50.4 ± 28.4 months. Sustained LVRR occurred in 57.6% of patients. The number of coronary arteries with severe stenosis (HR 0.69, 95% CI 0.55-0.86; p=0.001), New York Heart Association Functional Class (NYHA FC) (HR 0.39, 95% CI 0.27-0.54; p<0.001) as well as the severity of mitral regurgitation (MR) at the end of follow-up (HR 0.42, 95% CI 0.30-0.58; p<0.001) and the time until first event (HR 1.02, 95% CI 1.01-1.03; p<0.001) were independent predictors of left ventricular ejection fraction improvement. LVRR was tightly related to prognosis due to the fact that both improvement in cardiac function achieving normal or slightly impaired LVEF (HR 0.31, 95% CI 0.17-0.56; p<0.001) and shorter time to achieve LVRR (HR 0.99, 95% CI 0.98-0.99; p=0.017) formed part of the best model for predicting events in DCM.
  
  
  CONCLUSIONS
  More than half of the patients showed sustained LVRR associated with a significantly better prognosis. Fewer numbers of coronary arteries with severe stenosis, milder NYHA FC and the absence of significant MR at the end of follow-up as well as longer event free period formed a simple model to prognosticate LVRR. LVRR and the time to achieve it were strongly related to long term prognosis in patients with DCM.
authors.affiliation: Calahorra Hospital Foundation, La Rioja, Spain. Electronic address: isabelrz@hotmail.es.
authors.forename: Isabel
authors.initials: I
authors.lastname: Ruiz-Zamora
authors.affiliation: Poniente Hospital, Almería, Spain.
authors.forename: Jorge
authors.initials: J
authors.lastname: Rodriguez-Capitan
authors.affiliation: Heart Failure and Familial Cardiomyopathies Unit + IBIMA, Virgen de la Victoria University Hospital, Malaga, Spain.
authors.forename: Alicia
authors.initials: A
authors.lastname: Guerrero-Molina
authors.affiliation: Heart Failure and Familial Cardiomyopathies Unit + IBIMA, Virgen de la Victoria University Hospital, Malaga, Spain.
authors.forename: Luis
authors.initials: L
authors.lastname: Morcillo-Hidalgo
authors.affiliation: Virgen de la Victoria University Hospital, Malaga, Spain.
authors.forename: Isabel
authors.initials: I
authors.lastname: Rodriguez-Bailon
authors.affiliation: Virgen de la Victoria University Hospital, Malaga, Spain.
authors.forename: Juan Jose
authors.initials: JJ
authors.lastname: Gomez-Doblas
authors.affiliation: Virgen de la Victoria University Hospital, Malaga, Spain.
authors.forename: Eduardo
authors.initials: E
authors.lastname: de Teresa-Galvan
authors.affiliation: Calahorra Hospital Foundation, La Rioja, Spain.
authors.forename: Jose Manuel
authors.initials: JM
authors.lastname: Garcia-Pinilla
mesh_terms: D000368:Aged; D002311:Cardiomyopathy, Dilated / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology* / Q000601:surgery; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging / Q000503:physiopathology; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013318:Stroke Volume / Q000502:physiology*; D016277:Ventricular Function, Left / Q000502:physiology; D020257:Ventricular Remodeling / Q000502:physiology*
keywords: Dilated cardiomyopathy; Prognosis; Reverse remodeling; Ventricle