Background: Improved left ventricular (LV) function after pharmacotherapy is known to be associated with favorable prognosis in patients with dilated cardiomyopathy (DCM). However, the clinical significance and clinical variables associated with re-worsening LV function in patients with DCM has not been elucidated.
Methods and results: One hundred and eighty one newly-diagnosed DCM patients who received only pharmacotherapy were enrolled. Echocardiography was performed at 6, 12, 24, and 36 months. 128 patients who were increased in LV ejection fraction (EF) ≥10% after 12 months were divided into two groups according to change in LVEF after 24 months: not decreased of LVEF ≥10% (Improve: n=114), decreased of LVEF ≥10% after 24 months (Re-worse: n=12). Although there was no significant difference both baseline LVEF (31±9% vs 31±9%, P=0.87) and LVEF after 12 months pharmacotherapy (55±10% vs 55±10%, P=0.98) between two groups, LVEF in Re-worse groups was gradually declined. After 36 months, LVEF in Re-worse groups was significantly lower than that in RWLF patients (42±9% vs 58±9%, P<0.001, Figure A). Cardiac death, defined as sudden death and pump failure death, was observed in 13 (7%) patients following 69±46 months after 36 months pharmacotherapy. Kaplan-Meier analysis revealed that cardiac death in Re-worse group was significantly higher than that in Improve group (P<0.0001), whereas there was no significant difference between Re-worse group and patients who were not increased in LVEF ≥10% after 12 months (Not-improve: n=55, Figure B). Multivariate logistic analysis indicated higher Log plasma B-type natriuretic peptide after 12 months was an independent predictor for Re-worse group (odds ratio: 7.93, 95% confidence interval, 1.91-43.53, P=0.003) in patients who were increased in LVEF ≥10% after 12 months.
Conclusions: Re-worsening LV function is associated with poor cardiac outcome in patients with newly-diagnosed DCM.