Outcomes and predictors of recovery in acute-onset cardiomyopathy: A single-center experience of patients undergoing endomyocardial biopsy for new heart failure.
About one-third of patients with unexplained acute-onset heart failure (HF) recover left ventricular (LV) function; however, characterization of these patients in the setting of contemporary HF therapies is limited. We aim to describe baseline characteristics and predictors of recovery in patients with acute-onset cardiomyopathy.



We previously described 851 patients with unexplained HF undergoing endomyocardial biopsy. In this study, 235 patients with acute-onset HF were further retrospectively examined.



Follow-up LV ejection fraction (LVEF) was available for 138 patients. At 1 year, 48 of 138 (33%) had LVEF recovery (follow-up LVEF ≥50%), and 90 of 138 (65%) had incomplete or lack of recovery. Higher cardiac index (P=.019), smaller LV diastolic diameter (P=.002), and lack of an intraventricular conduction delay (IVCD) (P=.002) were associated with LVEF recovery. IVCD (P=.001) and myocarditis (P=.016) were independent predictors of the composite end point of death, LV assist device placement, and/or transplant at 1 year. Those with an IVCD had a significantly lower 1-year survival than those without (P=.007).



Patients with a smaller LV end-diastolic diameter, higher cardiac index, and lack of IVCD at presentation for acute-onset HF were more likely to have LVEF recovery. IVCD was a poor prognostic marker in all patients presenting with acute cardiomyopathy.
Departments of Medicine and Pathology, Johns Hopkins Hospital, Baltimore, MD.
Nisha A
NA
Gilotra
Minneapolis Heart Institute Foundation, Minneapolis, MN.
Mosi K
MK
Bennett
Cardiovascular Division, Washington University at St Louis School of Medicine, St Louis, MO.
Adam
A
Shpigel
Departments of Medicine and Pathology, Johns Hopkins Hospital, Baltimore, MD.
Haitham M
HM
Ahmed
Department of Medicine, New York University, New York City, NY.
Shaline
S
Rao
Summa Health, Akron, OH.
Justin M
JM
Dunn
Departments of Medicine and Pathology, Johns Hopkins Hospital, Baltimore, MD.
Colleen
C
Harrington
University of Minnesota, Minneapolis, MN.
Tasha B
TB
Freitag
Departments of Medicine and Pathology, Johns Hopkins Hospital, Baltimore, MD.
Marc K
MK
Halushka
Departments of Medicine and Pathology, Johns Hopkins Hospital, Baltimore, MD. Electronic address: Srusse14@jhmi.edu.
Stuart D
SD
Russell
D000208:Acute Disease; D000328:Adult; D000367:Age Factors; D000368:Aged; D001706:Biopsy; D053840:Brugada Syndrome / Q000453:epidemiology*; D000075224:Cardiac Conduction System Disease; D009202:Cardiomyopathies / Q000401:mortality / Q000473:pathology / Q000503:physiopathology*; D015897:Comorbidity; D005260:Female; D006333:Heart Failure / Q000401:mortality / Q000473:pathology / Q000503:physiopathology*; D016027:Heart Transplantation / Q000706:statistics & numerical data; D006353:Heart-Assist Devices / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009205:Myocarditis / Q000453:epidemiology*; D009206:Myocardium / Q000473:pathology; D011379:Prognosis; D020127:Recovery of Function; D012189:Retrospective Studies; D018487:Ventricular Dysfunction, Left / Q000401:mortality / Q000473:pathology / Q000503:physiopathology*; D016277:Ventricular Function, Left