Persistent recovery of normal left ventricular function and dimension in idiopathic dilated cardiomyopathy during
Insights
Apparent healing of dilated cardiomyopathy is possible in 9% of patients with optimal treatment. However, long-term outcomes show function decline in 37%, emphasizing the need for ongoing monitoring.
Area of Science:
- Cardiology
- Heart Failure Research
Background:
- Idiopathic dilated cardiomyopathy often shows improved left ventricular function with treatment.
- Long-term outcomes for patients with apparent recovery are not well understood.
- This study investigates the reality of 'healing' in dilated cardiomyopathy.
Purpose of the Study:
- To assess the existence and persistence of apparent healing in dilated cardiomyopathy.
- To evaluate the long-term prognosis of patients with normalized left ventricular function.
- To identify predictors of persistent apparent healing.
Main Methods:
- Evaluated 408 patients with dilated cardiomyopathy on tailored medical treatment.
- Defined persistent apparent healing as LVEF ≥50% and LV end-diastolic diameter ≤33 mm/m² at mid- and long-term follow-up.
- Assessed heart transplant-free survival and long-term functional changes.
Main Results:
- 15% of patients achieved apparent healing at mid-term (19 months).
- 9% showed persistent apparent healing at long-term follow-up (103 months).
- Persistent healing was linked to better heart transplant-free survival but 37% experienced functional decline over time.
Conclusions:
- Persistent long-term apparent healing occurs in a significant proportion of dilated cardiomyopathy patients.
- This healing is associated with stable clinical features but can involve long-term functional decline.
- Individualized, serial follow-up is crucial for all dilated cardiomyopathy patients due to unpredictable outcomes.
Background:
An important number of patients with idiopathic dilated cardiomyopathy have dramatically improved left ventricular function with optimal treatment; however, little is known about the evolution and long-term outcome of this subgroup, which shows apparent healing. This study assesses whether real healing actually exists in dilated cardiomyopathy.
Methods And Results:
Persistent apparent healing was evaluated among 408 patients with dilated cardiomyopathy receiving tailored medical treatment and followed over the very long-term. Persistent apparent healing was defined as left ventricular ejection fraction ≥50% and indexed left ventricular end-diastolic diameter ≤33 mm/m(2) at both mid-term (19±4 months) and long-term (103±9 months) follow-up. At mid-term, 63 of 408 patients (15%) were apparently healed; 38 (60%; 9%of the whole population) showed persistent apparent healing at long-term evaluation. No predictors of persistent apparent healing were found. Patients with persistent apparent healing showed better heart transplant–free survival at very long-term follow-up (95% versus 71%; P=0.014) compared with nonpersistently normalized patients. Nevertheless, in the very longterm, 37% of this subgroup experienced deterioration of left ventricular systolic function, and 5% died or had heart transplantation.
Conclusions:
Persistent long-term apparent healing was evident in a remarkable proportion of dilated cardiomyopathy patients receiving optimal medical treatment and was associated with stable normalization of main clinical and laboratory features. This condition can be characterized by a decline of left ventricular function over the very long term, highlighting the relevance of serial nd individualized follow-up in all patients with dilated cardiomyopathy, especially considering the absence of predictors for longterm apparent healing.
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