Aims: Improvement or fluctuations in the ejection fraction (LVEF) may occur in patients with dilated cardiomyopathy (DCM). Our aim was to examine the predictors and the implications of persistent, as compared to transient improvement in the LVEF in DCM patients.
Methods and Results: We studied 188 patients with non-ischemic DCM. Persistent improvement in LVEF (PIEF) was defined as LVEF increase by at least 10% compared to baseline, and found in 2 separate echo-Doppler exams performed at least 12 months apart. Increased LVEF in Echo2, which was not sustained in Echo3 was defined as transient improvement (TIEF).
Over an average follow-up of 6.8 years, PIEF occurred in 61(33%) patients, predicting a better long term outcome (p<0.001) in a combined end-point comprising death, heart transplantation or the need for a ventricular assist device. TIEF group had an intermediate course and were closer to non-improvers (p=0.003 vs. PIEF). Multivariate logistic regression identified the following independent predictors of PIEF: shorter disease duration, pregnancy-associated disease, left ventricular hypertrophy and LVEF ≤ 25%. A score to predict PIEF assigned 1 point to each of the following: disease duration < 3 years and no familial cardiomyopathy; pregnancy-associated presentation; basal LVEF ≤ 25%; left ventricular wall thickness ≥ 12. A score of ≥3 was present in 44% of the patients, reliably predicting PIEF in 91% (p=0.01).
Conclusion: Persistent improvement in LVEF using contemporary therapies is associated with improved long term prognosis. Baseline clinical parameters can be used to identify patients likely to demonstrate PIEF, thereby allowing tailored management in this population.
