Long-term outcomes and reverse remodelling in recently diagnosed unexplained left ventricular systolic dysfunction

Area of Science:

• Cardiology
• Heart Failure Research
• Clinical Outcomes

Background:

• Short-term studies show Left Ventricular Reverse Remodelling (LVRR) and favorable prognosis in patients with recently diagnosed non-ischaemic LV systolic dysfunction.
• The long-term clinical course and stability of LVRR in these patients require further investigation.

Purpose of the Study:

• To assess the long-term clinical course and stability of Left Ventricular Reverse Remodelling (LVRR) in patients with recently diagnosed non-ischaemic LV systolic dysfunction.
• To evaluate the association between LVRR and long-term prognosis, including mortality and heart failure hospitalizations.

Main Methods:

• Prospective study of 133 patients with unexplained LV systolic dysfunction and heart failure symptoms.
• Endomyocardial biopsy (EMB) at diagnosis, followed by serial echocardiographic and clinical follow-up over 5 years.
• LVRR defined by LVEF increase/normalization and LV end-diastolic diameter index (LVEDDi) decrease/normalization.

Main Results:

• LVRR was observed in 46% at 1 year, peaking at 60% by 2 years, and stabilizing around 50% at 5 years.
• During 5-year follow-up, 17% died, 2% underwent heart transplantation, and 12% were hospitalized for heart failure.
• LVRR at 1 year predicted lower mortality and heart failure hospitalization rates (P=0.025).

Conclusions:

• Left Ventricular Reverse Remodelling (LVRR) develops in over half of patients with recent unexplained LV systolic dysfunction within the first two years of optimal therapy.
• LVRR remains relatively stable over a 5-year follow-up period.
• Normalization of adverse LV remodelling is associated with favorable long-term outcomes, including reduced mortality and heart failure hospitalizations.