Clinical and demographic predictors of outcomes in recent onset dilated cardiomyopathy: results of the IMAC (Intervention in Myocarditis and Acute Cardiomyopathy) …

DM McNamara, RC Starling, LT Cooper… - Journal of the American …, 2011 - jacc.org
DM McNamara, RC Starling, LT Cooper, JP Boehmer, PJ Mather, KM Janosko, J Gorcsan…
Journal of the American College of Cardiology, 2011jacc.org
Objectives: We sought to determine clinical and demographic predictors of recovery of left
ventricular function for subjects with recent onset cardiomyopathy (ROCM). Background:
Although ROCM is a frequent reason for consultation and transplantation referral, its
prognosis and natural history on contemporary therapy are unknown. Methods: In the
multicenter IMAC (Intervention in Myocarditis and Acute Cardiomyopathy)-2 study, subjects
with a left ventricular ejection fraction (LVEF) of≤ 0.40, fewer than 6 months of symptom …
Objectives
We sought to determine clinical and demographic predictors of recovery of left ventricular function for subjects with recent onset cardiomyopathy (ROCM).
Background
Although ROCM is a frequent reason for consultation and transplantation referral, its prognosis and natural history on contemporary therapy are unknown.
Methods
In the multicenter IMAC (Intervention in Myocarditis and Acute Cardiomyopathy)-2 study, subjects with a left ventricular ejection fraction (LVEF) of ≤0.40, fewer than 6 months of symptom duration, and an evaluation consistent with idiopathic dilated cardiomyopathy or myocarditis were enrolled. LVEF was reassessed at 6 months, and subjects were followed up for 4 years. LVEF and event-free survival were compared by race, sex, and clinical phenotype.
Results
The cohort of 373 persons was 38% female and 21% black, with a mean age of 45 ± 14 years. At entry, 91% were receiving angiotensin-converting enzyme inhibitors or angiotensin receptor blockers and 82% were receiving beta-blockers, which increased to 92% and 94% at 6 months. LVEF was 0.24 ± 0.08 at entry and 0.40 ± 0.12 at 6 months (mean increase: 17 ± 13 ejection fraction units). Transplant-free survival at 1, 2, and 4 years was 94%, 92%, and 88%, respectively; survival free of heart failure hospitalization was 88%, 82%, and 78%, respectively. In analyses adjusted for sex, baseline LVEF, and blood pressure, LVEF at 6 months was significantly lower in blacks than in nonblacks (p = 0.02). Left ventricular end-diastolic diameter at presentation was the strongest predictor of LVEF at 6 months (p < 0.0001).
Conclusions
Outcomes in ROCM are favorable but differ by race. Left ventricular end-diastolic diameter by transthoracic echo at presentation was most predictive of subsequent myocardial recovery. (Genetic Modulation of Left Ventricular Recovery in Recent Onset Cardiomyopathy; NCT00575211)
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