Prevalence, predictors and prognosis of ventricular reverse remodeling in idiopathic dilated cardiomyopathy.
BACKGROUND
Cardiac remodeling is manifested as changes in size, shape and function of the heart. We studied the prevalence, prognosis and predictors of left ventricular reverse remodeling (LVRR) in idiopathic dilated cardiomyopathy (IDCM) after optimized medical therapy.


METHODS
A total of 113 IDCM patients were followed for 7.1±5.6 years. LVRR was defined as an increase of 10 units in ejection fraction (EF) and decrease in left ventricular diastolic diameter (LVDD), in the absence of resynchronization therapy.


RESULTS
Baseline EF was 27±8% and LVDD index was 37.1±6.3 mm/m(2). LVRR occurred in 34.5% within 22.6 months. Final EF was 47.5±10.1%, LVDD index was 30.2±3.9 mm/m(2). LVRR was associated with better NYHA class (I-II) and lower BNP (p<0.01) and all patients were alive. Univariate predictive factors of LVRR (p<0.05) were mild hypertension, atrial fibrillation, ventricular hypertrophy on ECG, absence of left bundle branch block, shorter QRS duration, higher hematocrit, lower LVDD index, higher peak oxygen uptake efficiency (VO2/log 10[VE]) and lower dVE/VCO2/VO2, treatment with angiotensin-converting enzyme inhibitors (ACEI)/angiotensin receptor blockers (ARB) and use of maximal doses of ACEI/ARB and beta-blockers. Multivariate regression analysis showed that higher doses of ACEI/ARB (OR: 0.32, 95% CI 0.11-0.92) were independently associated with LVRR. Non-transmural late enhancement on cardiac MRI was not a predictor of LVRR.


CONCLUSIONS
LVRR occurred in one third of IDCM patients, especially in those with mild hypertension and with less advanced disease, who may have benefited from maximal drug titration.
Cardiology Department, Hospital de São João, Porto, Portugal. Electronic address: sandra.maria.amorim@netcabo.pt.
Sandra
S
Amorim
Cardiology Department, Hospital de São João, Porto, Portugal.
Manuel
M
Campelo
Cardiology Department, Hospital de São João, Porto, Portugal.
Elisabete
E
Martins
Cardiology Department, Hospital de São João, Porto, Portugal.
Brenda
B
Moura
Cardiology Department, Hospital de São João, Porto, Portugal.
Alexandra
A
Sousa
Cardiology Department, Hospital de São João, Porto, Portugal.
Teresa
T
Pinho
Cardiology Department, Hospital de São João, Porto, Portugal.
José
J
Silva-Cardoso
Cardiology Department, Hospital de São João, Porto, Portugal.
Maria Júlia
MJ
Maciel
D002311:Cardiomyopathy, Dilated; D004452:Echocardiography; D005500:Follow-Up Studies; D006801:Humans; D015995:Prevalence; D011379:Prognosis; D016277:Ventricular Function, Left; D020257:Ventricular Remodeling
Dilated cardiomyopathy; Miocardiopatia dilatada; Prognosis; Prognóstico; Remodelagem reversa; Reverse remodeling