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LONG-TERM CLINICAL OUTCOMES AND LEFT VENTRICULAR REVERSE REMODELING IN PATIENTS WITH RECENTLY DIAGNOSED UNEXPLAINED DILATED CARDIOMYOPATHY
Topic: field
Type: Presentation - doctors , Number in the programme: 15
Kuchynka P.1, Podzimkova J.2, Marek J.2, Danek B.3, Vitkova I.4, Kreidlova M.5, Roblova L.2, Kovarnik T.2, Linhart A.1, Paleček T.1

1 II. interní klinika - klinika kardiologie a angiologie, 1. lékařská fakulta, Univerzita Karlova v Praze, Všeobecná fakultní nemocnice v Praze, Praha, 2 First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, 2nd Department of Medicine - Department of Cardiovascular Medicine, Praha, 3 University of Washington Medical Center, Division of Cardiology, Seattle, United States, 4 First Faculty of Medicine, Charles University and General University Hospital in Prague, Institute of Pathology, Praha, 5 First Faculty of Medicine, Charles University and General University Hospital in Prague, Institute of Medical Biochemistry and Laboratory Diagnostics, Praha


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.