Clinical and demographic predictors of outcomes in recent onset dilated cardiomyopathy: Results of the IMAC (intervention in myocarditis and acute cardiomyopathy)-2 study

Dennis M. McNamara, Randall C. Starling, Leslie T. Cooper, John P. Boehmer, Paul J. Mather, Karen M. Janosko, John Gorcsan, Kevin E. Kip, G. William Dec

Research output: Contribution to journalArticle

130 Scopus citations

Abstract

Objectives: We sought to determine clinical and demographic predictors of recovery of left ventricular function for subjects with recent onset cardiomyopathy (ROCM). Background: Although ROCM is a frequent reason for consultation and transplantation referral, its prognosis and natural history on contemporary therapy are unknown. Methods: In the multicenter IMAC (Intervention in Myocarditis and Acute Cardiomyopathy)-2 study, subjects with a left ventricular ejection fraction (LVEF) of ≤0.40, fewer than 6 months of symptom duration, and an evaluation consistent with idiopathic dilated cardiomyopathy or myocarditis were enrolled. LVEF was reassessed at 6 months, and subjects were followed up for 4 years. LVEF and event-free survival were compared by race, sex, and clinical phenotype. Results: The cohort of 373 persons was 38% female and 21% black, with a mean age of 45 ± 14 years. At entry, 91% were receiving angiotensin-converting enzyme inhibitors or angiotensin receptor blockers and 82% were receiving beta-blockers, which increased to 92% and 94% at 6 months. LVEF was 0.24 ± 0.08 at entry and 0.40 ± 0.12 at 6 months (mean increase: 17 ± 13 ejection fraction units). Transplant-free survival at 1, 2, and 4 years was 94%, 92%, and 88%, respectively; survival free of heart failure hospitalization was 88%, 82%, and 78%, respectively. In analyses adjusted for sex, baseline LVEF, and blood pressure, LVEF at 6 months was significantly lower in blacks than in nonblacks (p = 0.02). Left ventricular end-diastolic diameter at presentation was the strongest predictor of LVEF at 6 months (p < 0.0001). Conclusions: Outcomes in ROCM are favorable but differ by race. Left ventricular end-diastolic diameter by transthoracic echo at presentation was most predictive of subsequent myocardial recovery. (Genetic Modulation of Left Ventricular Recovery in Recent Onset Cardiomyopathy; NCT00575211)

Original languageEnglish
Pages (from-to)1112-1118
Number of pages7
JournalJournal of the American College of Cardiology
Volume58
Issue number11
DOIs
StatePublished - Sep 6 2011

Keywords

  • cardiomyopathy
  • echocardiography
  • myocardial function
  • outcomes
  • recovery

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