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Baseline Blood Pressure and Left Ventricular Reverse Remodeling in Dilated Cardiomyopathy with Spontaneous Mechanical

Mitsuhiro Watanabe1, Takeshi Kashimura1, Mitsuo Ishizuka1

  • 1Department of Cardiovascular Medicine, Niigata University Graduate School of Medical and Dental Sciences, Japan.

Internal Medicine (Tokyo, Japan)
|November 9, 2022
PubMed

Insights

Spontaneous mechanical alternans (MA) in dilated cardiomyopathy (DCM) patients is not always a poor prognostic sign. Left ventricular reverse remodeling (LVRR) probability is similar with or without MA, especially with preserved blood pressure.

Area of Science:

  • Cardiology
  • Heart Failure Research
  • Cardiovascular Physiology

Background:

  • Spontaneous mechanical alternans (MA), also known as pulsus alternans, is a recognized sign of poor prognosis in heart failure patients with hypertension or tachycardia.
  • However, left ventricular reverse remodeling (LVRR), a favorable prognostic indicator, can occur in some dilated cardiomyopathy (DCM) patients with MA following optimal medical therapy (OMT).
  • This challenges the traditional view of MA as solely a negative prognostic marker.

Purpose of the Study:

  • To investigate the likelihood of achieving LVRR in DCM patients presenting with spontaneous MA.
  • To determine if baseline blood pressure or heart rate can predict LVRR in DCM patients with spontaneous MA.
  • To compare LVRR rates between DCM patients with and without spontaneous MA.

Main Methods:

  • A retrospective observational study was conducted at a single center.
  • Data from newly diagnosed DCM patients between January 2017 and December 2020 were analyzed.
  • Spontaneous MA was identified during diagnostic cardiac catheterization from pressure waveforms; LVRR was assessed after OMT.

Main Results:

  • Of 33 DCM patients, 10 (30%) exhibited spontaneous MA.
  • LVRR rates were comparable between the MA group (60%) and the non-MA group (52%).
  • In the MA group, higher baseline systolic aortic pressure (>120 mmHg) correlated with LVRR, unlike baseline heart rate. In the non-MA group, LVRR was independent of baseline hemodynamics.

Conclusions:

  • The probability of LVRR in newly diagnosed DCM patients with spontaneous MA is similar to those without MA.
  • Spontaneous MA may not indicate a poor prognosis in DCM patients if they have preserved blood pressure.
  • Baseline systolic blood pressure, not heart rate, may be a predictor of LVRR in DCM patients with spontaneous MA.

Keywords:
dilated cardiomyopathyleft ventricular reverse remodelingmechanical alternansnon-ischemic cardiomyopathypulsus alternans

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