Ae. Steimle et al., PREDICTION OF IMPROVEMENT IN RECENT-ONSET CARDIOMYOPATHY AFTER REFERRAL FOR HEART-TRANSPLANTATION, Journal of the American College of Cardiology, 23(3), 1994, pp. 553-559
Objectives. The purpose of this investigation was to determine how oft
en left ventricular function improves in recent onset dilated cardiomy
opathy of sufficient severity to cause referral for heart transplantat
ion and how to predict this improvement at the time of evaluation for
transplantation. Background. Improvement has been reported to occur fr
equently in patients with acute dilated cardiomyopathy but has not bee
n described specifically in these patients referred for transplantatio
n. To avoid potentially needless transplantation, it would be useful t
o know the frequency of improvement and how to predict it in these pat
ients. Methods. A consecutive series of 297 patients with primary dila
ted cardiomyopathy evaluated for heart transplantation was reviewed to
identify those with onset of heart failure symptoms within the preced
ing 6 months and to examine their outcome. The clinical, echocardiogra
phic, hemodynamic and laboratory profiles of patients with improvement
in left ventricular function (defined as an increase in left ventricu
lar ejection fraction greater than or equal to 0.15 to a final ejectio
n fraction of greater than or equal to 0.30) were compared with those
of patients without improvement to assess which variables might predic
t improvement. Results. Of 49 patients with recent onset dilated cardi
omyopathy, 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 pat
ients without improvement with recent onset cardiomyopathy than in the
248 with chronic symptoms (p = 0.03) and in younger compared with old
er patients with recent onset cardiomyopathy (p = 0.0001). By multivar
iate analysis, predictors of improvement were shorter duration of symp
toms, lower pulmonary wedge and right atrial pressures and higher seru
m sodium levels. Conclusions. A minority of patients with dilated card
iomyopathy and symptoms for less than or equal to 6 months will have m
arked improvement in left ventricular function, after which prognosis
is excellent despite previous referral for heart transplantation. Thos
e with symptom duration >3 months and more severe initial decompensati
on as reflected by higher filling pressures and lower serum sodium lev
els are unlikely to show improvement and may require earlier considera
tion for heart transplantation.