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Multicenter Study
. 2011 Sep 6;58(11):1112-8.
doi: 10.1016/j.jacc.2011.05.033.

Clinical and demographic predictors of outcomes in recent onset dilated cardiomyopathy: results of the IMAC (Intervention in Myocarditis and Acute Cardiomyopathy)-2 study

Dennis M McNamara  1 , Randall C Starling, Leslie T Cooper, John P Boehmer, Paul J Mather, Karen M Janosko, John Gorcsan 3rd, Kevin E Kip, G William Dec; IMAC Investigators
Affiliations
Multicenter Study

Clinical and demographic predictors of outcomes in recent onset dilated cardiomyopathy: results of the IMAC (Intervention in Myocarditis and Acute Cardiomyopathy)-2 study

Dennis M McNamara et al. J Am Coll Cardiol. .

Erratum in

  • J Am Coll Cardiol. 2011 Oct 18;58(17):1832

Abstract

Objectives: We sought to determine clinical and demographic predictors of recovery of left ventricular function for subjects with recent onset cardiomyopathy (ROCM).

Background: Although ROCM is a frequent reason for consultation and transplantation referral, its prognosis and natural history on contemporary therapy are unknown.

Methods: In the multicenter IMAC (Intervention in Myocarditis and Acute Cardiomyopathy)-2 study, subjects with a left ventricular ejection fraction (LVEF) of ≤0.40, fewer than 6 months of symptom duration, and an evaluation consistent with idiopathic dilated cardiomyopathy or myocarditis were enrolled. LVEF was reassessed at 6 months, and subjects were followed up for 4 years. LVEF and event-free survival were compared by race, sex, and clinical phenotype.

Results: The cohort of 373 persons was 38% female and 21% black, with a mean age of 45 ± 14 years. At entry, 91% were receiving angiotensin-converting enzyme inhibitors or angiotensin receptor blockers and 82% were receiving beta-blockers, which increased to 92% and 94% at 6 months. LVEF was 0.24 ± 0.08 at entry and 0.40 ± 0.12 at 6 months (mean increase: 17 ± 13 ejection fraction units). Transplant-free survival at 1, 2, and 4 years was 94%, 92%, and 88%, respectively; survival free of heart failure hospitalization was 88%, 82%, and 78%, respectively. In analyses adjusted for sex, baseline LVEF, and blood pressure, LVEF at 6 months was significantly lower in blacks than in nonblacks (p = 0.02). Left ventricular end-diastolic diameter at presentation was the strongest predictor of LVEF at 6 months (p < 0.0001).

Conclusions: Outcomes in ROCM are favorable but differ by race. Left ventricular end-diastolic diameter by transthoracic echo at presentation was most predictive of subsequent myocardial recovery. (Genetic Modulation of Left Ventricular Recovery in Recent Onset Cardiomyopathy; NCT00575211).

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Figures

Figure 1
Figure 1. Transplant free Survival
a. Overall Cohort (n=373) b. Stratified by NYHA Functional Class (for class 1/2/3/4, n=68/172/108/25). Higher functional class is associated with poorer event free survival, p<0.0001.
Figure 1
Figure 1. Transplant free Survival
a. Overall Cohort (n=373) b. Stratified by NYHA Functional Class (for class 1/2/3/4, n=68/172/108/25). Higher functional class is associated with poorer event free survival, p<0.0001.
Figure 2
Figure 2. Clinical Outcomes by Race
a. Transplant free Survival (Blacks n=80 versus non-black, n=293). Event free survival is worse in Blacks, p=0.01. b. Survival Free from Heart Failure Hospitalization (Blacks n=80 versus non-black, n=293). Event free survival is worse in Blacks, p=0.001.
Figure 2
Figure 2. Clinical Outcomes by Race
a. Transplant free Survival (Blacks n=80 versus non-black, n=293). Event free survival is worse in Blacks, p=0.01. b. Survival Free from Heart Failure Hospitalization (Blacks n=80 versus non-black, n=293). Event free survival is worse in Blacks, p=0.001.
Figure 3
Figure 3. Myocardial Recovery By Left Ventricular End Diastolic Diameter (LVEDD)
a. Entire cohort: black=LVEDD<6.0cm, gray 6.0 to 7.0 cm, white>7.0 cm, LVEF entry (p<0.0001), LVEF six months (p<0.0001), LV change (p=0.005) all significantly greater with smaller LVEDD. b. Women: black=LVEDD≤5.5cm, gray 5.6 to 6.1 cm, white>6.1 cm, LVEF entry (p=0.0004), LVEF six months (p<0.0001), LV change (p=0.008). c. Men: black=LVEDD≤ 6.1cm, gray 6.2 to 6.9 cm, white>6.9 cm, LVEF entry (p<0.0001), LVEF six months (p<0.0001), LV change (p=0.37). Note: Label on each bar represents mean LVEF for the subset. Error bar represents standard deviation.
Figure 3
Figure 3. Myocardial Recovery By Left Ventricular End Diastolic Diameter (LVEDD)
a. Entire cohort: black=LVEDD<6.0cm, gray 6.0 to 7.0 cm, white>7.0 cm, LVEF entry (p<0.0001), LVEF six months (p<0.0001), LV change (p=0.005) all significantly greater with smaller LVEDD. b. Women: black=LVEDD≤5.5cm, gray 5.6 to 6.1 cm, white>6.1 cm, LVEF entry (p=0.0004), LVEF six months (p<0.0001), LV change (p=0.008). c. Men: black=LVEDD≤ 6.1cm, gray 6.2 to 6.9 cm, white>6.9 cm, LVEF entry (p<0.0001), LVEF six months (p<0.0001), LV change (p=0.37). Note: Label on each bar represents mean LVEF for the subset. Error bar represents standard deviation.
Figure 3
Figure 3. Myocardial Recovery By Left Ventricular End Diastolic Diameter (LVEDD)
a. Entire cohort: black=LVEDD<6.0cm, gray 6.0 to 7.0 cm, white>7.0 cm, LVEF entry (p<0.0001), LVEF six months (p<0.0001), LV change (p=0.005) all significantly greater with smaller LVEDD. b. Women: black=LVEDD≤5.5cm, gray 5.6 to 6.1 cm, white>6.1 cm, LVEF entry (p=0.0004), LVEF six months (p<0.0001), LV change (p=0.008). c. Men: black=LVEDD≤ 6.1cm, gray 6.2 to 6.9 cm, white>6.9 cm, LVEF entry (p<0.0001), LVEF six months (p<0.0001), LV change (p=0.37). Note: Label on each bar represents mean LVEF for the subset. Error bar represents standard deviation.
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