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ȣ - 550597 33 |
Clinical and Laboratory Predictors of Left Ventricular Reverse Remodeling in Patients with Non-ischemic Dilated Cardiomyopathy: Single Center 7-year Experience |
성균관의대 삼성서울병원 |
김은영, 최진오, 이상철, 박승우, 김덕경, 오재건 |
Background: Optimal medical therapy can lead to left ventricular (LV) reverse remodeling (LVRR) in non-ischemic dilated cardiomyopathy (NIDCM). The clinical variables associated with LVRR are poorly defined. We sought to determine the clinical predictors of LVRR and its prognostic role together with mid-term N-terminal pro-B-type natriuretic peptide (NT-proBNP) level in NIDCM.
Methods and Results: We evaluated 331 consecutive hospitalized NIDCM patients from heart failure database of our institute. Clinical and echocardiographic data were available for 255 (77%) patients at mid-term follow-up (16±7 months, range 5-27 months). Study subjects were followed thereafter with clinical endpoint of cardiovascular death, heart transplantation and hospitalization for heart failure with mean duration of 29±22 months (range; 2-72 months). LVRR was noted in 98 (38%) of 255 patients at mid-term. Baseline predictors of LVRR were higher systolic blood pressure, QRS duration <120 msec, use of beta-blocker and small indexed LV end-systolic dimension. In landmark survival analysis after mid-term evaluation, LVRR (HR 0.16, 95%CI 0.07-0.40; p<0.001), log NT-proBNP measured at mid-term (HR 2.18, 95%CI 1.54-3.08; p<0.001) and continuous use of beta-blocker (HR 0.55, 95%CI 0.33-0.91; p=0.021) were independent predictors of long-term combined clinical events after mid-term evaluation.
Conclusion: Monitoring of NIDCM patients with both cardiac imaging (LV structure) and neurohormonal status (NT-proBNP) at mid-term might be more helpful for estimation of long-term clinical prognosis of NIDCM
Key word: Left ventricular reverse remodeling, non-ischemic dilated cardiomyopathy
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Variable (n=258) |
OR (95% CI) |
p-value |
Systolic BP, per 10-mmHg increase |
1.24 (1.07-1.44) |
0.004 |
Prolongation of QRS (>120ms) |
0.31 (0.15-0.64) |
0.001 |
Beta-blocker |
2.36 (1.23-4.53) |
0.010 |
Log NT-proBNP at baseline |
1.15 (0.73-1.82) |
0.539 |
LV ejection fraction |
0.96 (0.91-1.00) |
0.051 |
LVESD index |
0.93(0.88-0.99) |
0.034 | *Adjusted covariates include male sex, age, systolic BP on admission, prolongation of QRS, use of beta-blocker, log NT-proBNP at baseline, LV ejection fraction, LVESD index and E/e’
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