Persistent recovery of normal left ventricular function and dimension in idiopathic dilated cardiomyopathy during long‐term follow‐up: does real healing exist?

• Published in: Journal of the American Heart Association Vol. 4; no. 1; p. e001504
• Main Authors: Merlo, Marco, Stolfo, Davide, Anzini, Marco, Negri, Francesco, Pinamonti, Bruno, Barbati, Giulia, Ramani, Federica, Lenarda, Andrea Di, Sinagra, Gianfranco
• Format: Journal Article
• Language: English
• Published: England Blackwell Publishing Ltd 13.01.2015
• Subjects: Adult; Analysis of Variance; Cardiomyopathy, Dilated - diagnostic imaging; Cardiomyopathy, Dilated - mortality; Cardiomyopathy, Dilated - therapy; Cohort Studies; Echocardiography, Doppler; Female; Follow-Up Studies; Humans; Italy; Kaplan-Meier Estimate; Male; Middle Aged; Monitoring, Physiologic - methods; Original Research; Quality of Life; Retrospective Studies; Risk Assessment; Severity of Illness Index; Survival Rate; Time Factors; Ventricular Function, Left - physiology; Ventricular Remodeling - physiology
• ISSN: 2047-9980; 2047-9980
• DOI: 10.1161/JAHA.114.001504

An important number of patients with idiopathic dilated cardiomyopathy have dramatically improved left ventricular function with optimal treatment; however, little is known about the evolution and long-term outcome of this subgroup, which shows apparent healing. This study assesses whether real healing actually exists in dilated cardiomyopathy. Persistent apparent healing was evaluated among 408 patients with dilated cardiomyopathy receiving tailored medical treatment and followed over the very long-term. Persistent apparent healing was defined as left ventricular ejection fraction ≥50% and indexed left ventricular end-diastolic diameter ≤33 mm/m(2) at both mid-term (19±4 months) and long-term (103±9 months) follow-up. At mid-term, 63 of 408 patients (15%) were apparently healed; 38 (60%; 9%of the whole population) showed persistent apparent healing at long-term evaluation. No predictors of persistent apparent healing were found. Patients with persistent apparent healing showed better heart transplant–free survival at very long-term follow-up (95% versus 71%; P=0.014) compared with nonpersistently normalized patients. Nevertheless, in the very longterm, 37% of this subgroup experienced deterioration of left ventricular systolic function, and 5% died or had heart transplantation. Persistent long-term apparent healing was evident in a remarkable proportion of dilated cardiomyopathy patients receiving optimal medical treatment and was associated with stable normalization of main clinical and laboratory features. This condition can be characterized by a decline of left ventricular function over the very long term, highlighting the relevance of serial nd individualized follow-up in all patients with dilated cardiomyopathy, especially considering the absence of predictors for longterm apparent healing.