Usefulness of left ventricular mass in predicting recovery of left ventricular systolic function in patients with symptomatic idiopathic dilated cardiomyopathy

Prognosis of idiopathic dilated cardiomyopathy (IDC) is variable. We determined the prognostic value of left ventricular (LV) mass and systolic and diastolic function in patients with IDC of <12 months duration. Clinical and echocardiographic assessment was performed at baseline and at 8 ± 6 months follow-up in 25 patients (47 ± 13 years) with IDC and an LV ejection fraction (LVEF₁) of <40% (22 ± 7%). Based on a follow-up LVEF (LVEF₂) of < or >40%, patients were divided into unimproved (n = 13, LVEF₂ = 21 ± 9%) and improved groups (n = 12, LVEF₂ = 51 ± 11%). There was no difference in the LVEF₁ (22 ± 8% vs 22 ± 6%), LV end-systolic (5.7 ± 0.8 vs 5.8 ± 0.9 cm) or end-diastolic (6.5 ± 0.6 vs 6.6 ± 0.9 cm) dimension, wall stress (102 ± 26 vs 99 ± 28 g/cm²), end-systolic (1.7 ± 0.3 vs 1.8 ± 0.2) or end-diastolic (1.7 ± 0.3 vs 1.6 ± 0.1) sphericity, dp/dt (582 ± 163 vs 678 ± 222 mm Hg/s), or right ventricular fractional shortening (20 ± 9% vs 27 ± 7%, p = 0.06) in unimproved and improved groups. LV mass was lower (1.00 ± 0.21 vs 1.38 ± 0.27 g/ml, p = 0007) and mitral inflow E-wave deceleration time shorter (97 ± 42 vs 164 ± 58 ms, p = 0007) in the unimproved versus the improved group. On Pearson correlation analysis, LV mass (r = 0.62, p = 0.001), deceleration time (r = 0.68, p = 0.0002), wall motion score index (r = -0.47, p = 02), and dp/dt (r = 0.52, p = 03) were the significant predictors of LVEF₂. There was correlation between LV mass (grams per milliliter) and deceleration time (r = 0.61, p = 0.001). During follow-up, death occurred in 1, and readmission for worsening heart failure in 4 patients in the unimproved group versus no hospitalization in the improved group. Thus, in patients with recent onset IDC, LV mass and diastolic function determine late outcome.