Epidemiology and Natural History of Recovery of Left Ventricular Function in Recent Onset Dilated Cardiomyopathies
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PREVENTION OF HEART FAILURE (M ST. JOHN SUTTON, SECTION EDITOR)
Epidemiology and Natural History of Recovery of Left Ventricular Function in Recent Onset Dilated Cardiomyopathies Michael M. Givertz & Douglas L. Mann
Published online: 8 September 2013 # Springer Science+Business Media New York 2013
Abstract Although the long term prognosis of patients with dilated cardiomyopathy (DCM) remains poor, approximately 25 % of DCM patients with recent onset of heart failure (< 6 months) have a relatively benign clinical course with a spontaneously improvement in symptoms and partial, or in some cases complete, recovery of left ventricular (LV) function. Despite the longstanding recognition of the clinical phenomenon of LV recovery, relatively little attention has been paid to the etiology and natural history of this important group of DCM patients. Accordingly, in the present review we will focus on the epidemiology and natural history of recent onset DCM in patients who undergo spontaneous resolution of symptoms that is accompanied by recovery of LV function.
mortality at 5 years [1], approximately 25 % of DCM patients with recent onset of heart failure (< 6 months) have a relatively benign clinical course with spontaneously improvement in symptoms and partial, or in some cases complete, recovery of left ventricular (LV) function. Despite the longstanding recognition of this clinical phenomenon, relatively little attention has been paid to the etiology and natural history of this group of DCM patients. Accordingly, this review will focus on the epidemiology and natural history of recent onset DCM patients, in whom spontaneous resolution of symptoms and recovery of LV function occurs.
Epidemiology of LV Recovery Keywords Left ventricular recovery . Reverse remodeling
Introduction The term dilated cardiomyopathy (DCM) refers to a large group of heterogeneous myocardial disorders that are characterized by ventricular dilation and depressed myocardial contractility in the absence of abnormal loading conditions (e.g., valvular disease or hypertension). Although the overall prognosis in patients with symptomatic heart failure and DCM is relatively poor, with 25 % mortality at 1 year and 50 % This research was supported by research funds from the N.I.H. (RO1 HL89543 and RO1 111094) M. M. Givertz Cardiovascular Division, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115, USA D. L. Mann (*) Division of Cardiology, Washington University School of Medicine, 660 S. Euclid Ave, Campus Box 8086, St. Louis, MO 63110, USA e-mail: [email protected]
For some etiologies of DCM, recovery of left ventricular (LV) function and reverse LV remodeling occur once the inciting adverse event that precipitated the episode of heart failure is resolved or removed. Indeed, in some situations, recovery of LV function can occur in a relatively high proportion of individuals, even when the severity of the heart failure or LV dysfunction has been quite severe. In contrast to the well described clinical phenomenon of reverse LV remodel
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