João L Cavalcante1, Josef Marek2, Richard Sheppard3, Randall C Starling4, Paul J Mather5, Jeffrey D Alexis6, Jagat Narula7, Dennis M McNamara2, John Gorcsan2. 1. Heart & Vascular Institute-UPMC, UPMC/University of Pittsburgh, 200 Lothrop Street, Scaife Hall, S-558, Pittsburgh, PA, USA cavalcantejl@upmc.edu. 2. Heart & Vascular Institute-UPMC, UPMC/University of Pittsburgh, 200 Lothrop Street, Scaife Hall, S-558, Pittsburgh, PA, USA. 3. Jewish General Hospital/McGill University, Montreal, Canada. 4. Cleveland Clinic Foundation, Cleveland, OH, USA. 5. Jefferson Medical College of Thomas Jefferson University, Philadelphia, PA, USA. 6. University of Rochester Medical Center, Rochester, NY, USA. 7. Mount Sinai Hospital, New York, NY, USA.
Abstract
AIMS: Patients with recent onset non-ischaemic cardiomyopathy have a variable clinical course with respect to recovery of left ventricular ejection fraction (LVEF). The aim of this study was to understand whether temporal changes in diastolic function (DF) are associated with clinical outcomes independent of LVEF recovery. METHODS AND RESULTS: The Intervention in Myocarditis and Acute Cardiomyopathy (IMAC)-2 study was a prospective, multicentre trial investigating myocardial recovery in subjects with symptoms onset of <6 months and LVEF ≤40% of non-ischaemic dilated cardiomyopathy related to idiopathic cardiomyopathy or myocarditis. LVEF and DF were measured at presentation and at 6-month follow-up. Of 147 patients (mean age 46 ± 14 years, 40% female), baseline LVEF was 23 ± 8%. At 6 months, LVEF improved to 41 ± 12%, with 71% increasing by at least 10% ejection fraction units. DF improved in 58%, was unchanged in 28%, and worsened in 14%. Over a mean follow-up of 1.8 ± 1.2 years, there were 18 events: 11 heart failure (HF) hospitalizations, 3 deaths, and 4 heart transplants. LVEF (HR = 0.94, 95% CI 0.91-0.98, P = 0.002) and DF improvements at 6 months (HR = 0.32, 95% CI 0.11-0.92, P = 0.03) were independently associated with lower likelihood for the combined end point of death, transplantation, and HF hospitalization. Diastolic functional improvement at 6-month follow-up was as prognostically important as LVEF recovery for these patients, and provided incremental prognostic value to the risk stratification (X(2) increased from 12.6 to 18, P = 0.02). CONCLUSION: In patients with recent onset non-ischaemic cardiomyopathy, DF recovery was associated with favourable outcomes independent of LVEF improvement, adding incremental prognostic value to these patients. Published on behalf of the European Society of Cardiology. All rights reserved.
AIMS: Patients with recent onset non-ischaemic cardiomyopathy have a variable clinical course with respect to recovery of left ventricular ejection fraction (LVEF). The aim of this study was to understand whether temporal changes in diastolic function (DF) are associated with clinical outcomes independent of LVEF recovery. METHODS AND RESULTS: The Intervention in Myocarditis and Acute Cardiomyopathy (IMAC)-2 study was a prospective, multicentre trial investigating myocardial recovery in subjects with symptoms onset of <6 months and LVEF ≤40% of non-ischaemic dilated cardiomyopathy related to idiopathic cardiomyopathy or myocarditis. LVEF and DF were measured at presentation and at 6-month follow-up. Of 147 patients (mean age 46 ± 14 years, 40% female), baseline LVEF was 23 ± 8%. At 6 months, LVEF improved to 41 ± 12%, with 71% increasing by at least 10% ejection fraction units. DF improved in 58%, was unchanged in 28%, and worsened in 14%. Over a mean follow-up of 1.8 ± 1.2 years, there were 18 events: 11 heart failure (HF) hospitalizations, 3 deaths, and 4 heart transplants. LVEF (HR = 0.94, 95% CI 0.91-0.98, P = 0.002) and DF improvements at 6 months (HR = 0.32, 95% CI 0.11-0.92, P = 0.03) were independently associated with lower likelihood for the combined end point of death, transplantation, and HF hospitalization. Diastolic functional improvement at 6-month follow-up was as prognostically important as LVEF recovery for these patients, and provided incremental prognostic value to the risk stratification (X(2) increased from 12.6 to 18, P = 0.02). CONCLUSION: In patients with recent onset non-ischaemic cardiomyopathy, DF recovery was associated with favourable outcomes independent of LVEF improvement, adding incremental prognostic value to these patients. Published on behalf of the European Society of Cardiology. All rights reserved.
Authors: S R Ommen; R A Nishimura; C P Appleton; F A Miller; J K Oh; M M Redfield; A J Tajik Journal: Circulation Date: 2000-10-10 Impact factor: 29.690
Authors: João L Cavalcante; Thomas H Marwick; Rory Hachamovitch; Zoran B Popovic; Nael Aldweib; Randall C Starling; Milind Y Desai; Scott D Flamm; Deborah H Kwon Journal: Am Heart J Date: 2014-04-16 Impact factor: 4.749
Authors: Garvan C Kane; Barry L Karon; Douglas W Mahoney; Margaret M Redfield; Veronique L Roger; John C Burnett; Steven J Jacobsen; Richard J Rodeheffer Journal: JAMA Date: 2011-08-24 Impact factor: 56.272
Authors: Jay L Ritzema; A Mark Richards; Ian G Crozier; Christopher F Frampton; Iain C Melton; Robert N Doughty; James T Stewart; Neal Eigler; James Whiting; William T Abraham; Richard W Troughton Journal: JACC Cardiovasc Imaging Date: 2011-09
Authors: D M McNamara; R Holubkov; R C Starling; G W Dec; E Loh; G Torre-Amione; A Gass; K Janosko; T Tokarczyk; P Kessler; D L Mann; A M Feldman Journal: Circulation Date: 2001-05-08 Impact factor: 29.690