Long‐term outcomes and reverse remodelling in recently diagnosed unexplained left ventricular systolic dysfunction
Abstract Aims In patients with recently diagnosed non‐ischaemic LV systolic dysfunction, left ventricular reverse remodelling (LVRR) and favourable prognosis has been documented in studies with short‐term follow‐up. The aim of our study was to assess the long‐term clinical course and stability of LV...
| Main Authors: | , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2024-04-01
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| Series: | ESC Heart Failure |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/ehf2.14643 |
| _version_ | 1827307794865324032 |
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| author | Petr Kuchynka Jana Podzimkova Josef Marek Barbara Anna Danek Ivana Vitkova Miluse Kreidlova Lenka Roblova Tomas Kovarnik Stanislav Simek Jan Horak Jan Habasko Ales Linhart Tomas Palecek |
| author_facet | Petr Kuchynka Jana Podzimkova Josef Marek Barbara Anna Danek Ivana Vitkova Miluse Kreidlova Lenka Roblova Tomas Kovarnik Stanislav Simek Jan Horak Jan Habasko Ales Linhart Tomas Palecek |
| author_sort | Petr Kuchynka |
| collection | DOAJ |
| description | Abstract Aims In patients with recently diagnosed non‐ischaemic LV systolic dysfunction, left ventricular reverse remodelling (LVRR) and favourable prognosis has been documented in studies with short‐term follow‐up. The aim of our study was to assess the long‐term clinical course and stability of LVRR in these patients. Methods and results We prospectively studied 133 patients (37 women; 55 [interquartile range 46, 61] years) with recently diagnosed unexplained LV systolic dysfunction, with heart failure symptoms lasting <6 months and LV ejection fraction <40% persisting after at least 1 week of therapy. All patients underwent endomyocardial biopsy (EMB) at the time of diagnosis and serial echocardiographic and clinical follow‐up over 5 years. LVRR was defined as the combined presence of (1) LVEF ≥ 50% or increase in LVEF ≥ 10% points and (2) decrease in LV end‐diastolic diameter index (LVEDDi) ≥ 10% or (3) LVEDDi ≤ 33 mm/m2. LVRR was observed in 46% patients at 1 year, in 60% at 2 years and 50% at 5 years. Additionally, 2% of patients underwent heart transplantation and 12% experienced heart failure hospitalization. During 5‐year follow‐up, 23 (17%) of the study cohort died. In multivariate analysis, independent predictors of mortality were baseline right atrial size (OR 1.097, CI 1.007–1.196), logBNP level (OR 2.02, CI 1.14–3.56), and PR interval (OR 1.02, CI 1.006–1.035) (P < 0.05 for all). The number of macrophages on EMB was associated with overall survival in univariate analysis only. LVRR at 1 year of follow‐up was associated with a lower rate of mortality and heart failure hospitalization (P = 0.025). In multivariate analysis, independent predictors of LVRR were left ventricular end‐diastolic volume index (OR 0.97, CI 0.946–0.988), LVEF (OR 0.89, CI 0.83–0.96), and diastolic blood pressure (OR 1.04, CI 1.01–1.08) (P < 0.05 for all). Conclusions LVRR occurs in over half of patients with recent onset unexplained LV systolic dysfunction during first 2 years of optimally guided heart failure therapy and then remains relatively stable during 5‐year follow‐up. Normalization of adverse LV remodelling corresponds to a low rate of mortality and heart failure hospitalizations during long‐term follow‐up. |
| first_indexed | 2024-04-24T18:45:35Z |
| format | Article |
| id | doaj.art-aed709ba0cec4dcdb89808d467a9a549 |
| institution | Directory Open Access Journal |
| issn | 2055-5822 |
| language | English |
| last_indexed | 2024-04-24T18:45:35Z |
| publishDate | 2024-04-01 |
| publisher | Wiley |
| record_format | Article |
| series | ESC Heart Failure |
| spelling | doaj.art-aed709ba0cec4dcdb89808d467a9a5492024-03-27T06:48:03ZengWileyESC Heart Failure2055-58222024-04-0111285987010.1002/ehf2.14643Long‐term outcomes and reverse remodelling in recently diagnosed unexplained left ventricular systolic dysfunctionPetr Kuchynka0Jana Podzimkova1Josef Marek2Barbara Anna Danek3Ivana Vitkova4Miluse Kreidlova5Lenka Roblova6Tomas Kovarnik7Stanislav Simek8Jan Horak9Jan Habasko10Ales Linhart11Tomas Palecek122nd Department of Medicine, Department of Cardiovascular Medicine, First Faculty of Medicine Charles University in Prague and General University Hospital in Prague Prague Czech Republic2nd Department of Medicine, Department of Cardiovascular Medicine, First Faculty of Medicine Charles University in Prague and General University Hospital in Prague Prague Czech Republic2nd Department of Medicine, Department of Cardiovascular Medicine, First Faculty of Medicine Charles University in Prague and General University Hospital in Prague Prague Czech RepublicDivision of Cardiology University of Washington Medical Center Seattle WA USAInstitute of Pathology, First Faculty of Medicine Charles University and General University Hospital in Prague Prague Czech RepublicInstitute of Medical Biochemistry and Laboratory Diagnostics, First Faculty of Medicine Charles University and General University Hospital in Prague Prague Czech Republic2nd Department of Medicine, Department of Cardiovascular Medicine, First Faculty of Medicine Charles University in Prague and General University Hospital in Prague Prague Czech Republic2nd Department of Medicine, Department of Cardiovascular Medicine, First Faculty of Medicine Charles University in Prague and General University Hospital in Prague Prague Czech Republic2nd Department of Medicine, Department of Cardiovascular Medicine, First Faculty of Medicine Charles University in Prague and General University Hospital in Prague Prague Czech Republic2nd Department of Medicine, Department of Cardiovascular Medicine, First Faculty of Medicine Charles University in Prague and General University Hospital in Prague Prague Czech Republic2nd Department of Medicine, Department of Cardiovascular Medicine, First Faculty of Medicine Charles University in Prague and General University Hospital in Prague Prague Czech Republic2nd Department of Medicine, Department of Cardiovascular Medicine, First Faculty of Medicine Charles University in Prague and General University Hospital in Prague Prague Czech Republic2nd Department of Medicine, Department of Cardiovascular Medicine, First Faculty of Medicine Charles University in Prague and General University Hospital in Prague Prague Czech RepublicAbstract Aims In patients with recently diagnosed non‐ischaemic LV systolic dysfunction, left ventricular reverse remodelling (LVRR) and favourable prognosis has been documented in studies with short‐term follow‐up. The aim of our study was to assess the long‐term clinical course and stability of LVRR in these patients. Methods and results We prospectively studied 133 patients (37 women; 55 [interquartile range 46, 61] years) with recently diagnosed unexplained LV systolic dysfunction, with heart failure symptoms lasting <6 months and LV ejection fraction <40% persisting after at least 1 week of therapy. All patients underwent endomyocardial biopsy (EMB) at the time of diagnosis and serial echocardiographic and clinical follow‐up over 5 years. LVRR was defined as the combined presence of (1) LVEF ≥ 50% or increase in LVEF ≥ 10% points and (2) decrease in LV end‐diastolic diameter index (LVEDDi) ≥ 10% or (3) LVEDDi ≤ 33 mm/m2. LVRR was observed in 46% patients at 1 year, in 60% at 2 years and 50% at 5 years. Additionally, 2% of patients underwent heart transplantation and 12% experienced heart failure hospitalization. During 5‐year follow‐up, 23 (17%) of the study cohort died. In multivariate analysis, independent predictors of mortality were baseline right atrial size (OR 1.097, CI 1.007–1.196), logBNP level (OR 2.02, CI 1.14–3.56), and PR interval (OR 1.02, CI 1.006–1.035) (P < 0.05 for all). The number of macrophages on EMB was associated with overall survival in univariate analysis only. LVRR at 1 year of follow‐up was associated with a lower rate of mortality and heart failure hospitalization (P = 0.025). In multivariate analysis, independent predictors of LVRR were left ventricular end‐diastolic volume index (OR 0.97, CI 0.946–0.988), LVEF (OR 0.89, CI 0.83–0.96), and diastolic blood pressure (OR 1.04, CI 1.01–1.08) (P < 0.05 for all). Conclusions LVRR occurs in over half of patients with recent onset unexplained LV systolic dysfunction during first 2 years of optimally guided heart failure therapy and then remains relatively stable during 5‐year follow‐up. Normalization of adverse LV remodelling corresponds to a low rate of mortality and heart failure hospitalizations during long‐term follow‐up.https://doi.org/10.1002/ehf2.14643Dilated cardiomyopathyEndomyocardial biopsyLeft ventricular systolic dysfunctionMortalityReverse remodelling |
| spellingShingle | Petr Kuchynka Jana Podzimkova Josef Marek Barbara Anna Danek Ivana Vitkova Miluse Kreidlova Lenka Roblova Tomas Kovarnik Stanislav Simek Jan Horak Jan Habasko Ales Linhart Tomas Palecek Long‐term outcomes and reverse remodelling in recently diagnosed unexplained left ventricular systolic dysfunction ESC Heart Failure Dilated cardiomyopathy Endomyocardial biopsy Left ventricular systolic dysfunction Mortality Reverse remodelling |
| title | Long‐term outcomes and reverse remodelling in recently diagnosed unexplained left ventricular systolic dysfunction |
| title_full | Long‐term outcomes and reverse remodelling in recently diagnosed unexplained left ventricular systolic dysfunction |
| title_fullStr | Long‐term outcomes and reverse remodelling in recently diagnosed unexplained left ventricular systolic dysfunction |
| title_full_unstemmed | Long‐term outcomes and reverse remodelling in recently diagnosed unexplained left ventricular systolic dysfunction |
| title_short | Long‐term outcomes and reverse remodelling in recently diagnosed unexplained left ventricular systolic dysfunction |
| title_sort | long term outcomes and reverse remodelling in recently diagnosed unexplained left ventricular systolic dysfunction |
| topic | Dilated cardiomyopathy Endomyocardial biopsy Left ventricular systolic dysfunction Mortality Reverse remodelling |
| url | https://doi.org/10.1002/ehf2.14643 |
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