Journal article
Long-term outcomes and reverse remodelling in recently diagnosed unexplained left ventricular systolic dysfunction
ESC Heart Failure, Vol.11(2), pp.859-870
04/2024
DOI: 10.1002/ehf2.14643
PMCID: PMC10966214
PMID: 38204216
Abstract
In patients with recently diagnosed non-ischaemic LV systolic dysfunction, left ventricular reverse remodelling (LVRR) and favourable prognosis has 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.
We prospectively studied 133 patients (37 women; 55 [interquartile range 46, 61] years) with recently diagnosed unexplained LV systolic dysfunction, with heart failure symptoms lasting <6 months and LV ejection fraction <40% persisting after at least 1 week of therapy. All patients underwent endomyocardial biopsy (EMB) at the time of diagnosis and serial echocardiographic and clinical follow-up over 5 years. LVRR was defined as the combined presence of (1) LVEF ≥ 50% or increase in LVEF ≥ 10% points and (2) decrease in LV end-diastolic diameter index (LVEDDi) ≥ 10% or (3) LVEDDi ≤ 33 mm/m
. LVRR was observed in 46% patients at 1 year, in 60% at 2 years and 50% at 5 years. Additionally, 2% of patients underwent heart transplantation and 12% experienced heart failure hospitalization. During 5-year follow-up, 23 (17%) of the study cohort died. In multivariate analysis, independent predictors of mortality were baseline right atrial size (OR 1.097, CI 1.007-1.196), logBNP level (OR 2.02, CI 1.14-3.56), and PR interval (OR 1.02, CI 1.006-1.035) (P < 0.05 for all). The number of macrophages on EMB was associated with overall survival in univariate analysis only. LVRR at 1 year of follow-up was associated with a lower rate of mortality and heart failure hospitalization (P = 0.025). In multivariate analysis, independent predictors of LVRR were left ventricular end-diastolic volume index (OR 0.97, CI 0.946-0.988), LVEF (OR 0.89, CI 0.83-0.96), and diastolic blood pressure (OR 1.04, CI 1.01-1.08) (P < 0.05 for all).
LVRR occurs in over half of patients with recent onset unexplained LV systolic dysfunction during first 2 years of optimally guided heart failure therapy and then remains relatively stable during 5-year follow-up. Normalization of adverse LV remodelling corresponds to a low rate of mortality and heart failure hospitalizations during long-term follow-up.
Details
- Title: Subtitle
- Long-term outcomes and reverse remodelling in recently diagnosed unexplained left ventricular systolic dysfunction
- Creators
- Petr Kuchynka - General University Hospital in PragueJana Podzimkova - General University Hospital in PragueJosef Marek - Charles UniversityBarbara Anna Danek - University of Washington Medical CenterIvana Vitkova - General University Hospital in PragueMiluse Kreidlova - Charles UniversityLenka Roblova - Charles UniversityTomas Kovarnik - Charles UniversityStanislav Simek - General University Hospital in PragueJan Horak - Charles UniversityJan Habasko - General University Hospital in PragueAles Linhart - General University Hospital in PragueTomas Palecek - General University Hospital in Prague
- Resource Type
- Journal article
- Publication Details
- ESC Heart Failure, Vol.11(2), pp.859-870
- DOI
- 10.1002/ehf2.14643
- PMID
- 38204216
- PMCID
- PMC10966214
- ISSN
- 2055-5822
- eISSN
- 2055-5822
- Grant note
- Charles University Research Program Cooperatio Cardiovascular Science
- Language
- English
- Date published
- 04/2024
- Academic Unit
- Electrical and Computer Engineering
- Record Identifier
- 9984627281802771
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