Why the study?
Tailored medical therapy can lead to left ventricular reverse remodeling in idiopathic dilated cardiomyopathy, but its prevalence and prognostic impact remain unclear.
Does lower pre-ablation CT-derived left ventricular extracellular volume predict left ventricular reverse remodeling after catheter ablation in patients with atrial fibrillation and LVEF ≤ 50%?
Cohort (n=102)
Yes
Does lower pre-ablation CT-derived left ventricular extracellular volume predict left ventricular reverse remodeling after catheter ablation in patients with atrial fibrillation and LVEF ≤ 50%?
Effect estimate: AUC 0.77 (95% CI 0.673-0.862)
Absolute Event Rate: 31.2% vs 37.6%
p-value: p=<0.001
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“Studies suggest that left ventricular ejection fraction might recover in up to 40% of patients with dilated cardiomyopathy. Younger patients, who are more likely to recover, have a low prevalence of comorbidities that might otherwise preclude withdrawing therapy. Therefore, although we agree that recovery, without alternative indications for therapy, occurs in a minority of patients with dilated cardiomyopathy, it is not rare.”
Pre-ablation CT-derived left ventricular extracellular volume independently predicts reverse remodeling after catheter ablation in patients with atrial fibrillation and reduced LVEF, offering a practical noninvasive biomarker to distinguish reversible from irreversible LV dysfunction.
OBJECTIVES: The purpose of this study was to determine the prevalence and prognostic role of left ventricular reverse remodeling (LVRR) in idiopathic dilated cardiomyopathy (IDCM). BACKGROUND: Tailored medical therapy can lead to LVRR in IDCM. The prevalence and prognostic impact of LVRR remain unclear. METHODS: We consecutively enrolled 361 IDCM patients. LVRR was defined as a left ventricular ejection fraction increase of ≥10 U or a left ventricular ejection fraction of ≥50% and a decrease in indexed left ventricular end-diastolic diameter of ≥10% or indexed left ventricular end-diastolic diameter of ≥33 mm/m(2) at 24 months (range 9 to 36 months). Follow-up echocardiographic data were available for 242 patients (67%), 34 (9%) died/underwent heart transplantation (HTx) before re-evaluation, and 85 (24%) did not have a complete re-evaluation. After re-evaluation, the surviving patients were followed for 110 ± 53 months; there were 55 deaths (23%) and 32 HTx (13%). RESULTS: LVRR was found in 89 of 242 patients (37%). Baseline predictors of LVRR were higher systolic blood pressure (p = 0.047) and the absence of left bundle branch block (p = 0.009). When added to a prognostic baseline model including male sex, heart failure duration, New York Heart Association functional classes III to IV, LVEF, significant mitral regurgitation, and beta-blockers, LVRR, New York Heart Association functional classes III to IV, and significant mitral regurgitation after 24 months emerged as independent predictors of death/HTx and heart failure death/HTx. The model including follow-up variables showed additional prognostic power with respect to baseline model (for death/HTx, area under the curve: 0.80 vs. 0.70, respectively, p = 0.004). Furthermore, only LVRR was significantly associated with sudden death/major ventricular arrhythmia in the long-term. CONCLUSIONS: LVRR characterized approximately one-third of IDCM patients surviving 2 years while receiving optimal medical therapy and allowed a more accurate long-term prognostic stratification of the disease.
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Merlo et al. (2011) conducted a cohort in Atrial fibrillation with left ventricular dysfunction (LVEF ≤ 50%) (n=102). CT-derived left ventricular extracellular volume (ECV) prior to catheter ablation vs. Patients without left ventricular reverse remodeling (higher CT-derived ECV) was evaluated on Left ventricular reverse remodeling (≥15% reduction in LVESV with recovery of LVEF > 50%, or an absolute increase in LVEF ≥ 15%) (AUC 0.77, 95% CI 0.673-0.862, p=<0.001).
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