Long-term outcomes of non-ischemic dilated cardiomyopathy patients with left ventricular ejection fraction ≤19% on medical therapy

Background: Patients with heart failure and reduced ejection fraction in low resource settings may not have access to devices and expensive therapeutic options. We followed up a cohort of patients with non-ischemic dilated cardiomyopathy (DCM) with very low left ventricle ejection fraction (LVEF <= 19%) on low cost medical therapy alone. By selecting patients with such low LVEF, this study was restricted to patients with severe disease. We studied long-term transplant free survival of these patients.Methods and results: The study enrolled 130 patients (83 men and 47 women) of DCM cohort with LVEF <= 19% from April 2003-December 2018 on medical therapy alone. Mean age was 40.35 +/- 13.9 years. Mean follow-up was 45.6 +/- 39 months while median follow-up was 39 months (range: 0-176 months). Patients on devices (ICD/CRT) for heart failure management were excluded. Fifty-four patients died and three underwent transplant during the study. Median survival was 86 months (S.E. 22.38). 113 patients had follow-up till end of study. In the worst case scenario, if all 17 patients who were lost to final follow-up were assumed to be dead, the median survival was still 57 (S.E.9.28) months. Higher baseline NYHA class, recurrent heart failure hospitalizations, absence of treatment with beta-blockers, angiotensin converting enzyme inhibitors/angiotensin receptor blockers and aldosterone antagonists were predictors of death on univariate analysis whereas none of these parameters were significant on multivariate analysis.Conclusions: Median survival of our DCM cohort with LVEF-19% on medical therapy was over 7 years. (C) 2020 Cardiological Society of India. Published by Elsevier B.V.