Left Ventricular Reverse Remodeling In Recent Onset Idiopathic Dilated Cardiomyopathy Using Contemporary Echo Techniques

Background: Early identification of patients with a likelihood of cardiac improvement has important implications for management strategies.Objectives: To evaluate whether tissue Doppler imaging (TDI) and two-dimensional (2D) strain measures may predict left ventricular (LV) improvement in patients with recent onset dilated cardiomyopathy (ROCM).Methods: Clinical and comprehensive echo were performed at baseline and at 6 months. Patients who achieved an increase of >= 10 LV ejection fraction (LVEF) units and LV reverse remodeling (LVRR) (group 1) and those who improved beyond the device threshold achieving LVEF of >= 0.40 (group 2) were compared to patients who did not improve to this level.Results: Among 37 patients with ROCM (mean age 56.3 12.9 years and LVEF 29.1 +/- 7.0%), 48% achieved LVEF >= 0.40 and 37.8% demonstrated LVRR. Patients with LVEF improvement >= 40% presented at diagnosis with higher LVEF (P = 0.006), smaller LV end-diastolic diameter (LVEDd) (P = 0.04), higher E' septal (P = 0.02), lower E/E' ratio (P = 0.02), increased circumferential strain (P = 0.04), and apical rotation (P = 0.009). Apical rotation and LVEDd were found to be independent predictors of LVRR. End-systolic LV volume was a significant predictor of LVEF improvement (>= 40%).Conclusions: Nearly half of the patients with ROCM demonstrated cardiac function improvement beyond the device threshold by 6 months. Apical rotation was introduced in our study as 2D strain prognostic parameter and found to be an independent predictor of LVRR. LV size and volume were predictors of LV improvement.