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Relapse in patients with non-ischemic dilated cardiomyopathy and improved ejection fraction managed with medical

Arghadip Bose1, Ajay Bahl1, Ankur Gupta1

  • 1Department of Cardiology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India.

Indian Heart Journal
|May 4, 2026
PubMed

Insights

Relapse is common in non-ischemic dilated cardiomyopathy (DCM) patients who improve their left ventricular ejection fraction (LVEF). Nearly 50% of patients with improved LVEF relapse, highlighting the need for long-term management strategies.

Area of Science:

  • Cardiology
  • Heart Failure Research
  • Clinical Outcomes

Background:

  • Relapse is a significant concern for patients with non-ischemic dilated cardiomyopathy (DCM) experiencing improved left ventricular ejection fraction (LVEF).
  • Understanding long-term outcomes and relapse risks in this patient group is crucial for effective medical management.

Purpose of the Study:

  • To evaluate the long-term outcomes of non-ischemic DCM patients with improved LVEF.
  • To analyze the risk and predictors of relapse in patients managed with medical therapy.

Main Methods:

  • A retrospective, observational study of adult patients with non-ischemic DCM.
  • Inclusion criteria: baseline LVEF <40% with improvement to ≥40% (absolute increase ≥10%) on medical therapy.
  • Follow-up until the end of the study period to assess outcomes.

Main Results:

  • 23.9% of 548 non-ischemic DCM patients achieved improved LVEF.
  • Of those with improved LVEF, 45% relapsed, with relapse occurring at a median of 57 months.
  • Long-term relapse rates reached 23.7% by 5 years and 37.4% by 10 years.

Conclusions:

  • A significant proportion (45%) of non-ischemic DCM patients with improved LVEF experience relapse.
  • Relapse risk persists long-term, with nearly half relapsing over 5 years post-improvement.
  • Diabetes mellitus and increased left ventricular internal diameter at improvement are independent predictors of relapse.
Abstract

Keywords:
Heart failure with improved ejection fractionNon-ischemic dilated cardiomyopathyRelapse

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