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LONG-TERM CLINICAL OUTCOMES AND LEFT VENTRICULAR REVERSE REMODELING IN PATIENTS WITH RECENTLY DIAGNOSED UNEXPLAINED DILATED CARDIOMYOPATHY

P. Kuchynka, J. Podzimkova, J. Marek, B. Danek, I. Vitkova, M. Kreidlova, L. Roblova, T. Kovarnik, A. Linhart, T. Paleček (Praha, Seattle, United States)
Topic: a general field
Type: Presentation - doctors, CCRID 2022

Background: Left ventricular reverse remodelling (LVRR) and favourable prognosis of patients with recently diagnosed dilated cardiomyopathy (DCM) have been documented in studies with short-term follow-up. The aim of our study was to assess the long-term clinical course and stability of LVRR in these patients.
Methods: We prospectively studied 133 patients with recently diagnosed unexplained DCM, with heart failure symptoms lasting < 6 months and LV ejection fraction < 40% persisting after at least one week of therapy. All had endomyocardial biopsy (EMB) at the time of diagnosis and serial echocardiographic and clinical follow-up over five years.
Results: LVRR was observed in 46 % patients at one year, in 60 % at two years and 50% at five years. Additionally, 2 % of patients underwent heart transplantation and 12% experienced heart failure hospitalization. In multivariate analysis, baseline right atrial size, BNP level, and PR interval were independently associated with mortality (p < 0.05 for all). The number of macrophages in EMB was associated with overall survival in univariate analysis only. LVRR at one year of follow-up was associated with lower rate of mortality and heart failure hospitalization (p = 0.025).
Conclusions: LVRR occurs in over half of patients with recent onset unexplained DCM during first two years of optimally guided heart failure therapy and then remains relatively stable during five-year follow-up. The reversion of the process of adverse LV remodeling corresponds to a low rate of mortality and heart failure hospitalizations during long-term follow-up.