Prediction of improvement in recent onset cardiomyopathy after referral for heart transplantation

Ahmanson-University of California, Los Angeles Cardiomyopathy Center.

OBJECTIVES. The purpose of this investigation was to determine how often left ventricular function improves in recent onset dilated cardiomyopathy of sufficient severity to cause referral for heart transplantation and how to predict this improvement at the time of evaluation for transplantation. BACKGROUND. Improvement has been reported to occur frequently in patients with acute dilated cardiomyopathy but has not been described specifically in these patients referred for transplantation. To avoid potentially needless transplantation, it would be useful to know the frequency of improvement and how to predict it in these patients. METHODS. A consecutive series of 297 patients with primary dilated cardiomyopathy evaluated for heart transplantation was reviewed to identify those with onset of heart failure symptoms within the preceding 6 months and to examine their outcome. The clinical, echocardiographic, hemodynamic and laboratory profiles of patients with improvement in left ventricular function (defined as an increase in left ventricular ejection fraction > or = 0.15 to a final ejection fraction of > or = 0.30) were compared with those of patients without improvement to assess which variables might predict improvement. RESULTS. Of 49 patients with recent onset dilated cardiomyopathy, 13 (27%) showed improvement, with an increase in mean left ventricular ejection fraction from 0.22 +/- 0.08 to 0.49 +/- 0.09. All patients with improvement had survived without heart transplantation at 43 +/- 29 months. Survival time was shorter in the remaining 36 patients without improvement with recent onset cardiomyopathy than in the 248 with chronic symptoms (p = 0.03) and in younger compared with older patients with recent onset cardiomyopathy (p = 0.0001). By multivariate analysis, predictors of improvement were shorter duration of symptoms, lower pulmonary wedge and right atrial pressures and higher serum sodium levels. CONCLUSIONS. A minority of patients with dilated cardiomyopathy and symptoms for < or = 6 months will have marked improvement in left ventricular function, after which prognosis is excellent despite previous referral for heart transplantation. Those with symptom duration > 3 months and more severe initial decompensation as reflected by higher filling pressures and lower serum sodium levels are unlikely to show improvement and may require earlier consideration for heart transplantation.

This article has been cited by other articles:

				D. M. McNamara, R. C. Starling, L. T. Cooper, J. P. Boehmer, P. J. Mather, K. M. Janosko, J. Gorcsan III, K. E. Kip, G. W. Dec, and IMAC Investigators Clinical and Demographic Predictors of Outcomes in Recent Onset Dilated Cardiomyopathy: Results of the IMAC (Intervention in Myocarditis and Acute Cardiomyopathy)-2 Study J. Am. Coll. Cardiol., September 6, 2011; 58(11): 1112 - 1118. [Abstract] [Full Text] [PDF]

				K. Rasi, J. Piuhola, M. Czabanka, R. Sormunen, M. Ilves, H. Leskinen, J. Rysa, R. Kerkela, P. Janmey, R. Heljasvaara, et al. Collagen XV Is Necessary for Modeling of the Extracellular Matrix and Its Deficiency Predisposes to Cardiomyopathy Circ. Res., November 12, 2010; 107(10): 1241 - 1252. [Abstract] [Full Text] [PDF]

				A. Verma, Z. Wulffhart, D. Lakkireddy, Y. Khaykin, A. Kaplan, B. Sarak, M. Biria, J. Pillarisetti, P. Bhat, L. Di Biase, et al. Incidence of left ventricular function improvement after primary prevention ICD implantation for non-ischaemic dilated cardiomyopathy: a multicentre experience Heart, April 1, 2010; 96(7): 510 - 515. [Abstract] [Full Text] [PDF]

				O. M. Hess, W. McKenna, and H.-P. Schultheiss CHAPTER 18 Myocardial Disease ESC Textbook of Cardiovascular Medicine, January 1, 2009; 2(1): med-9780199566990-chapter - med-9780199566990-chapter. [Abstract] [Full Text] [PDF]

				F. E. Marchlinski and M. Jessup Timing the Implantation of Implantable Cardioverter-Defibrillators in Patients With Nonischemic Cardiomyopathy J. Am. Coll. Cardiol., June 20, 2006; 47(12): 2483 - 2485. [Full Text] [PDF]

				R. Sheppard, M. Bedi, T. Kubota, M. J. Semigran, W. Dec, R. Holubkov, A. M. Feldman, W. D. Rosenblum, C. F. McTiernan, D. M. McNamara, et al. Myocardial Expression of Fas and Recovery of Left Ventricular Function in Patients With Recent-Onset Cardiomyopathy J. Am. Coll. Cardiol., September 20, 2005; 46(6): 1036 - 1042. [Abstract] [Full Text] [PDF]

				N. de Jonge, D. F. van Wichen, M. E. I. Schipper, J. R. Lahpor, F. H. J. Gmelig-Meyling, E. O. Robles de Medina, and R. A. de Weger Left ventricular assist device in end-stage heart failure: persistence of structural myocyte damage after unloading: An immunohistochemical analysis of the contractile myofilaments J. Am. Coll. Cardiol., March 20, 2002; 39(6): 963 - 969. [Abstract] [Full Text] [PDF]

				M. Cicoira, L. Zanolla, L. Latina, A. Rossi, G. Golia, G. Brighetti, and P. Zardini Frequency, prognosis and predictors of improvement of systolic left ventricular function in patients with 'classical' clinical diagnosis of idiopathic dilated cardiomyopathy Eur J Heart Fail, June 1, 2001; 3(3): 323 - 330. [Abstract] [Full Text] [PDF]

				D. M. McNamara, R. Holubkov, R. C. Starling, G. W. Dec, E. Loh, G. Torre-Amione, A. Gass, K. Janosko, T. Tokarczyk, P. Kessler, et al. Controlled Trial of Intravenous Immune Globulin in Recent-Onset Dilated Cardiomyopathy Circulation, May 8, 2001; 103(18): 2254 - 2259. [Abstract] [Full Text] [PDF]

				H. M. Krumholz, D. W. Baker, C. M. Ashton, S. B. Dunbar, G. C. Friesinger, E. P. Havranek, M. A. Hlatky, M. Konstam, D. L. Ordin, I. L. Pina, et al. Evaluating Quality of Care for Patients With Heart Failure Circulation, March 28, 2000; 101(12): e122 - e140. [Full Text] [PDF]

				T. Z. Naqvi, R. K. Goel, J. S. Forrester, and R. J. Siegel Myocardial contractile reserve on dobutamine echocardiography predicts late spontaneous improvement in cardiac function in patients with recent onset idiopathic dilated cardiomyopathy J. Am. Coll. Cardiol., November 1, 1999; 34(5): 1537 - 1544. [Abstract] [Full Text] [PDF]

				H Kitaoka, J Takata, T Yabe, N Hitomi, T Furuno, and Y L Doi Low dose dobutamine stress echocardiography predicts the improvement of left ventricular systolic function in dilated cardiomyopathy Heart, May 1, 1999; 81(5): 523 - 527. [Abstract] [Full Text]

				M. Senni, R. J. Rodeheffer, C. M. Tribouilloy, J. M. Evans, S. J. Jacobsen, K. R. Bailey, and M. M. Redfield Use of echocardiography in the management of congestive heart failure in the community J. Am. Coll. Cardiol., January 1, 1999; 33(1): 164 - 170. [Abstract] [Full Text] [PDF]

				D. M. Mancini, A. Beniaminovitz, H. Levin, K. Catanese, M. Flannery, M. DiTullio, S. Savin, M. E. Cordisco, E. Rose, and M. Oz Low Incidence of Myocardial Recovery After Left Ventricular Assist Device Implantation in Patients With Chronic Heart Failure Circulation, December 1, 1998; 98(22): 2383 - 2389. [Abstract] [Full Text] [PDF]

				M. A. Mathier, G. A. Rose, M. A. Fifer, M. I. Miyamoto, R. E. Dinsmore, H. H. Castano, G. W. Dec, I. F. Palacios, and M. J. Semigran Coronary endothelial dysfunction in patients with acute-onset idiopathic dilated cardiomyopathy J. Am. Coll. Cardiol., July 1, 1998; 32(1): 216 - 224. [Abstract] [Full Text] [PDF]

				M. L. Dickstein Anesthesia for Heart Transplantation Seminars in Cardiothoracic and Vascular Anesthesia, July 1, 1998; 2(2): 131 - 139. [Abstract] [PDF]

				D. M. McNamara, W. D. Rosenblum, K. M. Janosko, M. K. Trost, F. S. Villaneuva, A.J. Demetris, S. Murali, and A. M. Feldman Intravenous Immune Globulin in the Therapy of Myocarditis and Acute Cardiomyopathy Circulation, June 3, 1997; 95(11): 2476 - 2478. [Abstract] [Full Text]

				B. J. Amsel, H. De Raedt, I. E. Rodrigus, L. Haenen, P. Druwe, A. Vorlat, C. G. Colpaert, and A. C. Moulijn Biventricular Assist for Severe Acute Rheumatic Pancarditis Ann. Thorac. Surg., July 1, 1996; 62(1): 267 - 269. [Abstract] [Full Text]

				L. W. Stevenson Patient Selection for Mechanical Bridging to Transplantation Ann. Thorac. Surg., January 1, 1996; 61(1): 380 - 387. [Abstract] [Full Text]

				L. F. P. Moreira, N. A. G. Stolf, E. A. Bocchi, F. Bacal, P. M. Pego-Fernandes, H. Absensur, J. C. Meneghetti, and A. D. Jatene Clinical and left ventricular function outcomes up to five years after dynamic cardiomyoplasty J. Thorac. Cardiovasc. Surg., February 1, 1995; 109(2): 353 - 363. [Abstract] [Full Text]