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Dilated cardiomyopathy with re-worsening left ventricular ejection fraction
Takeru Nabeta1, Takayuki Inomata2, Shunsuke Ishii3
1Department of Cardiovascular Medicine, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan. nabetake@med.kitasato-u.ac.jp.
Heart and Vessels
|June 27, 2018
Summary
Re-worsening left ventricular ejection fraction (LVEF) in dilated cardiomyopathy (DCM) patients, despite initial improvement, is linked to poor cardiac outcomes. Older age and persistently high brain natriuretic peptide (BNP) levels predict this LVEF decline.
Area of Science:
- Cardiology
- Heart Failure Research
- Pharmacotherapy Studies
Background:
- Dilated cardiomyopathy (DCM) can present with initial improvements in left ventricular ejection fraction (LVEF) following pharmacotherapy.
- A subset of DCM patients experience a re-worsening of LVEF after initial recovery, necessitating further investigation into associated factors and outcomes.
Purpose of the Study:
- To analyze cardiac outcomes and clinical variables associated with the re-worsening of LVEF in patients with newly diagnosed DCM.
- To identify predictors of LVEF re-worsening and its impact on major cardiac events.
Main Methods:
- A cohort of 180 newly diagnosed DCM patients treated solely with pharmacotherapy was retrospectively analyzed.
- Echocardiography was performed at 6, 12, 24, and 36 months. Patients were categorized into 'Improved', 'Re-worse', and 'Not-improved' LVEF groups.
- Clinical variables, including brain natriuretic peptide (BNP) levels, and major cardiac events were assessed over 36 months.
Main Results:
- The 'Re-worse' group (7%) was older and had higher post-12-month BNP levels compared to the 'Improved' group (63%).
- Major cardiac events occurred in 7% of patients within 36 months.
- The 'Re-worse' group demonstrated a significantly higher risk of cardiac events (HR 11.7) compared to the 'Improved' group.
Conclusions:
- Re-worsening LVEF in DCM patients treated with pharmacotherapy is associated with adverse cardiac outcomes.
- Advanced age and persistently elevated BNP levels after initial LVEF improvement are significant predictors of LVEF re-worsening in DCM.
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