Background: The identification of patients with lack of improvement of LV function is important for consideration of early AICD implantation. We sought to identify measures associated with LV improvement in patients with recent onset idiopathic cardiomyopathy (ROICM) on contemporary medical therapy.
Methods and Patients: Out of 450 patients with systolic LV dysfunction followed in our heart failure clinic, 33 were defined as ROICM (LVEF<0.40, < 6 months of symptoms). Patients with CRT during follow-up and other forms of DCM were excluded. Complete echo studies were done including Tissue Doppler and 2D strain imaging at baseline and 6 months. Patients who achieved an increase in LVEF to ≥40 and 10 LVEF units (reverse remodeling) were compared to those who did not improve to this magnitude. The frequency of LV function recovery (LVEF≥50) was compared with 29 patients with peripartum cardiomyopathy (PPCM).
Results: Thirty three patients with ROICM (27 men, mean age 58±14 years and LVEF 28 ± 8%) were enrolled. Overall, 53 % demonstrated an increase at 6 months of ≥10 EF units, 53% achieved an LVEF ≥ 0.40, and 16% demonstrated LV recovery. Patients who achieved LVEF ≥40, had at presentation: higher LVEF 31±7 vs 25±5%, p=0.009; smaller LVDd 53± 8 vs 59±8 mm, p=0.05; lower LV filling pressures LV E/E’ 9±4 vs 12±6, p=0.04; better longitudinal -11 vs -7%, p=0.03, and circumpherential strain -8 vs -5%, p=0.01. In addition, they had lower incidence of LBBB (p=0.02) and more patients with FC 1-2 (p=0.02). The rates of LV recovery were significantly lower in patients with ROICM compared with PPCM patients (16% vs 72%, p<0.01).
Conclusion: On contemporary therapy, more than half of patients with ROICM demonstrated reverse remodeling achieving LVEF of ≥0.40 and increase of more than 10 EF units. However, patient with ROICM had much lesser likelihood of LV recovery compared with patients with PPCM.
