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The natural history of acute dilated cardiomyopathy

G William Dec1

  • 1Boston, Massachusetts.

Transactions of the American Clinical and Climatological Association
|August 16, 2014
PubMed

Insights

Acute dilated cardiomyopathy (ADCM) treatment has improved significantly, with higher survival rates in contemporary patients compared to earlier eras. Aggressive therapies like ACE-I/ARBs and beta-blockers enhance left ventricular ejection fraction (LVEF) and transplantation-free survival.

Area of Science:

  • Cardiology
  • Internal Medicine

Background:

  • Acute dilated cardiomyopathy (ADCM) is a significant cause for cardiac transplant referral.
  • The prognosis and natural history of ADCM on current therapies are not well-established.

Purpose of the Study:

  • To evaluate the natural history and prognosis of ADCM in contemporary patients treated with modern pharmacologic therapy.
  • To compare current outcomes with historical data from 1975-2000.

Main Methods:

  • The Multicenter Intervention in Myocarditis and Acute Cardiomyopathy (IMAC)-2 trial enrolled 373 patients with ADCM (LVEF ≤ 40%, heart failure symptoms < 6 months).
  • Historical data was gathered from a MEDLINE search of observational studies published between 1975 and 2000.

Main Results:

  • Mean LVEF improved from 24% to 40% with ACE-I/ARB and beta-blocker therapy.
  • Transplantation-free survival at 1, 2, and 4 years was 94%, 92%, and 86%, respectively, significantly higher than in the prior era.
  • Smaller LV dimension and higher systolic blood pressure predicted LVEF improvement, while black race and higher NYHA class were associated with lower final LVEF.

Conclusions:

  • Contemporary diagnosis and aggressive pharmacologic therapy have led to improved prognosis in ADCM.
  • Earlier intervention and advanced treatments contribute to better outcomes and higher survival rates.
Abstract

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