Cardiomyopathy
Prevalence, predictors, and prognosis of reversal of maladaptive remodeling with intensive medical therapy in idiopathic dilated cardiomyopathy

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Abstract

Some recent trials have shown that angiotensin-converting enzyme (ACE) inhibitors and/or β blockers can improve left ventricular (LV) function and decrease LV mass in patients with idiopathic dilated cardiomyopathy (IDC). We assessed the prevalence and predictors of patients with IDC that showed marked reverse remodeling (a decrease in LV end-diastolic dimension ≥5 mm to a final LV end-diastolic dimension ≤55 mm and an increase in percent LV fractional shortening ≥5% to a final percent fractional shortening of ≥25% and a decrease in LV mass ≥10%) after 2 years of intensive therapy with ACE inhibitors and/or β blockers. In 78 patients with IDC (mean age 51 ± 14 years), the clinical, echocardiographic, hemodynamic, laboratory, and endomyocardial biopsy data were evaluated at diagnosis and serial echocardiography was performed for 2 years. After 2 years of therapy, 20 of 78 patients (26%) showed marked reverse remodeling. Multivariate analysis revealed that higher systolic blood pressure (135 ± 17 vs 120 ± 16 mm Hg, p <0.001) and lower pulmonary arterial wedge pressure (7 ± 3 vs 12 ± 8 mm Hg, p <0.01) at diagnosis were independent predictors of reverse remodeling. Then, we further analyzed the prognosis of these patients for a mean of 50 ± 32 months; 5-year survival (p <0.02) and event-free rates (p = 0.001) were better in patients with reverse remodeling than in patients without reverse remodeling.

Section snippets

Study patients

In this study, 88 patients (66 men and 22 women, mean age 51 ± 14 years) with IDC who were admitted to our hospital and followed up in the outpatient clinic of our institute after discharge from 1984 to 1996 were enrolled. IDC was defined as both LV end-diastolic dimension >55 mm and LV percent fractional shortening <25% using M-mode echocardiography, and a LV ejection fraction <50% using left ventriculography, in the absence of significant coronary artery disease, other specific heart disease

Clinical outcome (Figures 1 to 3)

Of 88 patients enrolled after initial assessment, 10 patients were excluded during the 2-year treatment period because they stopped attending our institute. Therefore, the variables from 78 patients were analyzed.

After 1 year, 11 patients showed reverse remodeling and 67 did not. After 2 years, another 9 patients met the criteria for reverse remodeling. Thus, after 2 years of treatment, 20 patients (26%) showed marked reverse remodeling (group 1) and 58 patients (74%) did not (group 2) (Figure

Discussion

Our study is the first to clearly demonstrate the prevalence, predictors, and prognosis of the marked reverse remodeling in patients with IDC who are undergoing intensive medical therapy. This study indicated that 20 of 78 patients (26%) with IDC showed reverse remodeling after 2 years of intensive therapy with ACE inhibitors and/or β blockers. Reverse remodeling was more common in patients with higher systolic blood pressure and lower pulmonary arterial wedge pressure at diagnosis.

Acknowledgements

We gratefully thank Drs. Yoshio Takeuchi and Hiroya Kawai for collecting the data.

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