TY - JOUR
T1 - Clinical and demographic predictors of outcomes in recent onset dilated cardiomyopathy
T2 - Results of the IMAC (intervention in myocarditis and acute cardiomyopathy)-2 study
AU - McNamara, Dennis M.
AU - Starling, Randall C.
AU - Cooper, Leslie T.
AU - Boehmer, John P.
AU - Mather, Paul J.
AU - Janosko, Karen M.
AU - Gorcsan, John
AU - Kip, Kevin E.
AU - Dec, G. William
N1 - Funding Information:
This study was supported by National Heart, Lung, and Blood Institute contracts HL075038, HL086918, and HL69912, National Institutes of Health, Bethesda, Maryland. Dr. Starling is on the advisory board of Medtronic and Novartis; has received research support from Novartis; and has stock options in Cardiomens. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
PY - 2011/9/6
Y1 - 2011/9/6
N2 - 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)
AB - 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)
KW - cardiomyopathy
KW - echocardiography
KW - myocardial function
KW - outcomes
KW - recovery
UR - http://www.scopus.com/inward/record.url?scp=80052390541&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=80052390541&partnerID=8YFLogxK
U2 - 10.1016/j.jacc.2011.05.033
DO - 10.1016/j.jacc.2011.05.033
M3 - Article
C2 - 21884947
AN - SCOPUS:80052390541
SN - 0735-1097
VL - 58
SP - 1112
EP - 1118
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 11
ER -