Frequency, prognosis and predictors of improvement of systolic left ventricular function in patients with 'classical' clinical diagnosis of idiopathic dilated cardiomyopathy

In patients with dilated cardiomyopathy (DCM) of different aetiologies, a v ariable frequency of improvement in the left ventricular (LV) systolic func tion has been reported, while in patients with a 'classic' idiopathic DCM, the frequency of improvement is still under debate, and clinical and haemod ynamic predictors of recovery of the LV function are needed. The aim of the present study was to determine the frequency of improvement in the LV syst olic function in idiopathic DCM and to identify predictors of reversibility of the impaired LV contractility. A sample of 98 consecutive patients with idiopathic DCM was retrospectively evaluated. Echocardiographic and Dopple r measurements were directly taken from the routine echo-report. LV systoli c function was assessed semiquantitatively using a score index (SFSI). Acco rding to the improvement in the LV systolic function, the patients were div ided into group 1 patients with improvement, and group 2 patients without i mprovement. During a follow-up of at. least 12 months, 19 patients (19%) sh owed an improvement, with a significant increase in the mean SFSI; all thes e group 1 patients survived without heart transplant; in group 2, 18 patien ts (23%) died and 3 (4%) received a heart transplant. Patients in group 1 h ad a significantly shorter duration of symptoms (P = 0.0045), a younger age (P = 0.006), a shorter DtE (P = 0.04), a lower SFSI (P < 0.01), a worse NY HA class (P < 0.001) and more frequently had a history of hypertension (P < 0.0001). The same variables were significant predictors of improvement at the univariate analysis. At the multivariate logistic regression analysis, a shorter duration of symptoms (P = 0.02), a history of hypertension (P = 0 .003), and a worse NYHA class (P = 0.01) were independent predictors of imp rovement. A relatively large percentage of patients with an idiopathic DCM will have a marked improvement in the LV systolic function. This is more li kely to happen in the presence of a short duration of symptoms and a histor y of hypertension. After an improvement, the prognosis is excellent. (C) 20 01 European Society of Cardiology. All rights reserved.