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Left ventricular end-diastolic diameter predictive of myocardial recovery
McNamara D. J Am Coll Cardiol. 2011;58:1112-1118.
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Subsequent myocardial recovery was predicted most with left ventricular end-diastolic diameter by transthoracic echo at presentation, according to a study.
Three hundred seventy-three participants with an LV ejection fraction of 40% or less, fewer than 6 months of symptom duration, and evaluation consistent with idiopathic dilated cardiomyopathy or myocarditis were enrolled in the IMAC-2 study from May 2002 to December 2008. To exclude coronary disease, participants underwent angiography or noninvasive screening, and transthoracic echocardiography to rule out valvular disease. Transthoracic echocardiography was also assessed at 6 months. Researchers collected demographic information that included self-designated race (white, black, Asian or other). Participants were followed up for 4 years. LVEF and event-free survival were compared by race, sex and clinical phenotype, according to the study.
Overall, researchers found that the strongest predictor of LVEF at 6 months was LV end-diastolic diameter at presentation. At the start of the study, 12% (n=44) of participants underwent endomyocardial biopsy. There was inflammation in 4% (n=15) and myocarditis in 2.6% (n=10) of participants. According to the study, 92% of participants were receiving an ACE inhibitor or angiotensin receptor blocker, 94% were receiving beta-blockers and 20% had an implantable cardioverter defibrillator at 6 months. Forty-five percent of participants were NYHA Class I; 44% were Class II; 9% were Class III; and 1% were Class IV. At follow-up, 4% (n=14) of participants died, 5% (n=17) had transplantations, 12% (n=45) were hospitalized for HF in the absence of death or transplantation and 17% (n=62) were hospitalized for HF in aggregate with a survival of 98% at 1 year, 96% at 2 years and 94% at 4 years; transplant-free survival of 94% at 1 year, 92% at 2 years and 88% at 4 years; and survival free of the composite endpoint of 88% at 1 year, 82% at 2 years and 78% at 4 years. Researchers also found that myocardial recovery was more evident in women (P=.004), and lower in blacks (P=.007) at 6 months.
Disclosure: Dr. McNamara reports no relevant financial disclosures.
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