Predictors of Left Ventricular Reverse Remodeling and Subsequent Outcome in Nonischemic Dilated Cardiomyopathy

Abstract

Background: Optimal medical therapy can lead to left ventricular (LV) reverse remodeling (LVRR) in nonischemic dilated cardiomyopathy (NIDCM). However, because the clinical variables associated with LVRR are poorly defined, we sought to identify them and their prognostic role, and to evaluate the role of initial and midterm levels of N-terminal pro-B-type natriuretic peptide (NT-proBNP) in the long-term follow-up of patients with NIDCM. Methods and Results: We evaluated 329 consecutive hospitalized patients with NIDCM by reviewing the records in the institutional heart failure database. Clinical and echocardiographic data were available for 253 (77%) patients at the midterm follow-up (16±7 months). The patients were followed thereafter until the combined endpoint of cardiovascular death, heart transplantation, or hospitalization for heart failure. LVRR was noted in 97 (38%) of 253 patients at midterm. The baseline predictors of LVRR were higher systolic blood pressure, QRS duration <120ms, use of a β-blocker, and a small indexed LV end-systolic dimension. In landmark survival analysis from the midterm evaluation, LVRR, low midterm NT-proBNP level, and continuous use of a β-blocker were independently related to good long-term results. Conclusions: Monitoring of patients with NIDCM using both cardiac imaging of the LV structure and by assessing neurohormonal status (NT-proBNP level) at the midterm follow-up might be clinically useful for predicting the long-term clinical prognosis of NIDCM.  (Circ J 2013; 77: 462–469)