Clinical Determinants and Prognosis of Left Ventricular Reverse Remodelling in Non-Ischemic Dilated Cardiomyopathy
Por:
Diez-Lopez, C, Salazar-Mendiguchia, J, Garcia-Romero, E, Fuentes, L, Lupon, J, Bayes-Genis, A, Manito, N, De Antonio, M, Moliner, P, Zamora, E, Catala-Ruiz, P, Cainzos-Achirica, M, Comin-Colet, J, Gonzalez-Costello, J
Publicada:
1 ene 2022
Resumen:
Aims: Non-ischaemic dilated cardiomyopathy (NIDCM) is characterized by left ventricular (LV) chamber enlargement and systolic dysfunction in the absence of coronary artery disease. Left ventricular reverse remodelling (LVRR) is the ability of a dilated ventricle to restore its normal size, shape and function. We sought to determine the frequency, clinical predictors and prognostic implications of LVRR, in a cohort of heart failure (HF) patients with NIDCM. Methods: We conducted a multicentre observational, retrospective cohort study of patients with NIDCM, with prospective serial echocardiography evaluations. LVRR was defined as an increase of >= 15% in left ventricular ejection fraction (LVEF) or as a LVEF increase >= 10% plus reduction of LV end-systolic diameter index >= 20%. We used multivariable logistic regression analyses to identify the baseline clinical predictors of LVRR and evaluate the prognostic impact of LVRR. Results: LVRR was achieved in 42.5% of 527 patients with NIDCM during the first year of follow-up (median LVEF 49%, median change +22%), Alcoholic aetiology, HF duration, baseline LVEF and the absence of LBBB (plus NT-proBNP levels when in the model), were the strongest predictors of LVRR. During a median follow-up of 47 months, 134 patients died (25.4%) and 7 patients (1.3%) received a heart transplant. Patients with LVRR presented better outcomes, regardless of other clinical conditions. Conclusions: In patients with NIDCM, LVRR was frequent and was associated with improved prognosis. Major clinical predictors of LVRR were alcoholic cardiomyopathy, absence of LBBB, shorter HF duration, and lower baseline LVEF and NT-proBNP levels. Our study advocates for clinical phenotyping of non-ischaemic dilated cardiomyopathy and intense gold-standard treatment optimization of patients according to current guidelines and recommendations in specialized HF units.
Filiaciones:
Diez-Lopez, C:
Bellvitge Univ Hosp, Dept Cardiol, Adv Heart Failure Unit, Barcelona 08907, Spain
Bellvitge Univ Hosp, Dept Cardiol, Barcelona 08907, Spain
Bellvitge Biomed Res Inst IDIBELL, Barcelona 08907, Spain
Salazar-Mendiguchia, J:
Bellvitge Univ Hosp, Dept Cardiol, Adv Heart Failure Unit, Barcelona 08907, Spain
Bellvitge Univ Hosp, Dept Cardiol, Barcelona 08907, Spain
Garcia-Romero, E:
Bellvitge Univ Hosp, Dept Cardiol, Adv Heart Failure Unit, Barcelona 08907, Spain
Bellvitge Univ Hosp, Dept Cardiol, Barcelona 08907, Spain
Bellvitge Biomed Res Inst IDIBELL, Barcelona 08907, Spain
Fuentes, L:
Bellvitge Univ Hosp, Dept Cardiol, Barcelona 08907, Spain
Bellvitge Biomed Res Inst IDIBELL, Barcelona 08907, Spain
Lupon, J:
Univ Barcelona, Dept Med, Barcelona 08907, Spain
Hosp Badalona Germans Trias & Pujol, Dept Cardiol, Heart Failure Unit, Badalona 08916, Spain
Bayes-Genis, A:
Univ Barcelona, Dept Med, Barcelona 08907, Spain
Hosp Badalona Germans Trias & Pujol, Dept Cardiol, Heart Failure Unit, Badalona 08916, Spain
Inst Salud Carlos III, CIBERCV CB16 11 00403, Madrid 28029, Spain
Manito, N:
Bellvitge Univ Hosp, Dept Cardiol, Adv Heart Failure Unit, Barcelona 08907, Spain
Bellvitge Univ Hosp, Dept Cardiol, Barcelona 08907, Spain
De Antonio, M:
Inst Salud Carlos III, CIBERCV CB16 11 00403, Madrid 28029, Spain
Moliner, P:
Bellvitge Biomed Res Inst IDIBELL, Barcelona 08907, Spain
Bellvitge Univ Hosp, Dept Cardiol, Community Heart Failure Program, Barcelona 08907, Spain
Zamora, E:
Univ Barcelona, Dept Med, Barcelona 08907, Spain
Hosp Badalona Germans Trias & Pujol, Dept Cardiol, Heart Failure Unit, Badalona 08916, Spain
Inst Salud Carlos III, CIBERCV CB16 11 00403, Madrid 28029, Spain
Catala-Ruiz, P:
Bellvitge Univ Hosp, Dept Cardiol, Adv Heart Failure Unit, Barcelona 08907, Spain
Bellvitge Univ Hosp, Dept Cardiol, Barcelona 08907, Spain
Bellvitge Biomed Res Inst IDIBELL, Barcelona 08907, Spain
Cainzos-Achirica, M:
Johns Hopkins Med Inst, Johns Hopkins Ciccarone Ctr Prevent Cardiovasc Di, Baltimore, MD 21093 USA
RTI Hlth Solut, Pharmacoepidemiol & Risk Management, Barcelona 08028, Spain
Comin-Colet, J:
Bellvitge Univ Hosp, Dept Cardiol, Barcelona 08907, Spain
Bellvitge Biomed Res Inst IDIBELL, Barcelona 08907, Spain
Bellvitge Univ Hosp, Dept Cardiol, Community Heart Failure Program, Barcelona 08907, Spain
Gonzalez-Costello, J:
Bellvitge Univ Hosp, Dept Cardiol, Adv Heart Failure Unit, Barcelona 08907, Spain
Bellvitge Univ Hosp, Dept Cardiol, Barcelona 08907, Spain
Bellvitge Biomed Res Inst IDIBELL, Barcelona 08907, Spain
Green Published, gold
|