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

Abstract

Background: 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.

Methods and results: 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.

Conclusions: 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.

Figure 1.

Kaplan–Meier curves for very long‐term heart transplant‐free survival of patients who were apparently healed and not apparently healed and alive at mid‐term. Dotted lines represent apparently healed patients; solid lines represent patients who were not apparently healed. HTx indicates heart transplant.

Figure 2.

Flowchart of the long‐term evolution of the study population. All analyzed patients underwent a complete echocardiographic evaluation at each follow‐up. CRT indicates cardiac resynchronization therapy; HTx, heart transplant; ICD, implantable cardioverter‐defibrillator.

Figure 3.

Longitudinal long‐term trends of main clinical and laboratory features in patients who were persistently apparently healed and nonpersistently apparently healed. All analyzed patients underwent a complete echocardiographic evaluation at each follow‐up. Solid lines represent persistently apparently healed patients; broken lines represent nonpersistently apparently healed patients. iLVEDD indicates indexed left ventricular end‐diastolic diameter; iLVEDV, indexed left ventricular end‐diastolic volume; LVEF, left ventricular ejection fraction; LVRFP, left ventricular restrictive filling pattern; MR, mitral regurgitation; NYHA, New York Heart Association.

Figure 4.

Kaplan–Meier curves for very long‐term heart transplant‐free survival of patients who were persistently apparently healed vs nonpersistently apparently healed and alive at long‐term follow‐up. HTx indicates heart transplant.