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Early vs. late reverse ventricular remodeling in patients with cardiomyopathy.

Abstract：

BACKGROUND:Predictors of left ventricular reverse remodeling (LVRR) and differences in the time taken to achieve LVRR remain unclear. METHODS:We consecutively registered 129 patients with severe cardiomyopathy admitted with heart failure (HF). Patients were followed for a median of 778.0 days (IQ: 457.0, 1078.0). LVRR was defined as a decrease in indexed left ventricular systolic dimension of at least 15% additional to a 25% improvement in left ventricular ejection fraction at outpatient check-up compared with discharge. LVRR accomplishment within 400 days was defined as early-LVRR opposing the remaining late-LVRR patients. Primary endpoint was a composite of all-cause mortality and HF re-hospitalization. RESULTS:LVRR was observed in 51 patients (39.5%). Baseline predictors for LVRR were age younger than 60 years (OR, 3.27; 95% CI 1.04-10.37, p=0.043), no history of previous HF hospitalization (OR, 0.32; 95% CI 0.12-0.86, p=0.025), and systolic blood pressure (sBP) >100mmHg at discharge (OR, 4.39; 95% CI 1.39-13.81, p=0.011). Overall, there were 51 endpoint events [LVRR 11 (21.6%) vs. non-LVRR 40 (49.4%), p<0.001]. LVRR was a significant predictor of favorable prognosis (HR, 3.77; 95% CI 1.68-8.47, p<0.001). Notably, 41 (80.4%) patients qualified for early-LVRR. Early-LVRR was associated with better prognosis compared with late-LVRR [early-LVRR 6 (14.6%) vs. late-LVRR 5 (50.0%), p=0.066]. Among assessed variables, sBP >100mmHg at discharge was a significant predictor of early-LVRR (OR, 10.87; 95% CI 1.19-100.0, p=0.034). CONCLUSION:Prognosis was improved in patients who achieved LVRR. Early-LVRR tended to be an advantage in terms of long-term prognosis. Higher sBP was a predictor not only for all-LVRR but also early-LVRR.

journal_name

J Cardiol

journal_title

Journal of cardiology

authors

Banno A,Kohsaka S,Inohara T,Koide K,Shiraishi Y,Kohno T,Sano M,Yoshikawa T,Fukuda K

doi

10.1016/j.jjcc.2015.07.021

subject

Has Abstract

pub_date

2016-07-01 00:00:00

pages

57-63

issue

1

eissn

0914-5087

issn

1876-4738

pii

S0914-5087(15)00254-3

journal_volume

68

pub_type

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