Outcomes and predictors of recovery in acute-onset cardiomyopathy: A single-center experience of patients undergoing endomyocardial biopsy for new heart failure

Nisha Gilotra, Mosi K. Bennett, Adam Shpigel, Haitham M. Ahmed, Shaline Rao, Justin M. Dunn, Colleen Harrington, Tasha B. Freitag, Marc K Halushka, Stuart D. Russell

Research output: Contribution to journalArticle

Abstract

Background About one-third of patients with unexplained acute-onset heart failure (HF) recover left ventricular (LV) function; however, characterization of these patients in the setting of contemporary HF therapies is limited. We aim to describe baseline characteristics and predictors of recovery in patients with acute-onset cardiomyopathy. Methods We previously described 851 patients with unexplained HF undergoing endomyocardial biopsy. In this study, 235 patients with acute-onset HF were further retrospectively examined. Results Follow-up LV ejection fraction (LVEF) was available for 138 patients. At 1 year, 48 of 138 (33%) had LVEF recovery (follow-up LVEF ≥50%), and 90 of 138 (65%) had incomplete or lack of recovery. Higher cardiac index (P = .019), smaller LV diastolic diameter (P = .002), and lack of an intraventricular conduction delay (IVCD) (P = .002) were associated with LVEF recovery. IVCD (P = .001) and myocarditis (P = .016) were independent predictors of the composite end point of death, LV assist device placement, and/or transplant at 1 year. Those with an IVCD had a significantly lower 1-year survival than those without (P = .007). Conclusions Patients with a smaller LV end-diastolic diameter, higher cardiac index, and lack of IVCD at presentation for acute-onset HF were more likely to have LVEF recovery. IVCD was a poor prognostic marker in all patients presenting with acute cardiomyopathy.

Original languageEnglish (US)
Pages (from-to)116-126
Number of pages11
JournalAmerican Heart Journal
Volume179
DOIs
StatePublished - Sep 1 2016

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Cardiomyopathies
Heart Failure
Biopsy
Heart-Assist Devices
Myocarditis
Left Ventricular Function
Stroke Volume
Transplants
Survival

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Outcomes and predictors of recovery in acute-onset cardiomyopathy : A single-center experience of patients undergoing endomyocardial biopsy for new heart failure. / Gilotra, Nisha; Bennett, Mosi K.; Shpigel, Adam; Ahmed, Haitham M.; Rao, Shaline; Dunn, Justin M.; Harrington, Colleen; Freitag, Tasha B.; Halushka, Marc K; Russell, Stuart D.

In: American Heart Journal, Vol. 179, 01.09.2016, p. 116-126.

Research output: Contribution to journalArticle

Gilotra, Nisha ; Bennett, Mosi K. ; Shpigel, Adam ; Ahmed, Haitham M. ; Rao, Shaline ; Dunn, Justin M. ; Harrington, Colleen ; Freitag, Tasha B. ; Halushka, Marc K ; Russell, Stuart D. / Outcomes and predictors of recovery in acute-onset cardiomyopathy : A single-center experience of patients undergoing endomyocardial biopsy for new heart failure. In: American Heart Journal. 2016 ; Vol. 179. pp. 116-126.
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abstract = "Background About one-third of patients with unexplained acute-onset heart failure (HF) recover left ventricular (LV) function; however, characterization of these patients in the setting of contemporary HF therapies is limited. We aim to describe baseline characteristics and predictors of recovery in patients with acute-onset cardiomyopathy. Methods We previously described 851 patients with unexplained HF undergoing endomyocardial biopsy. In this study, 235 patients with acute-onset HF were further retrospectively examined. Results Follow-up LV ejection fraction (LVEF) was available for 138 patients. At 1 year, 48 of 138 (33{\%}) had LVEF recovery (follow-up LVEF ≥50{\%}), and 90 of 138 (65{\%}) had incomplete or lack of recovery. Higher cardiac index (P = .019), smaller LV diastolic diameter (P = .002), and lack of an intraventricular conduction delay (IVCD) (P = .002) were associated with LVEF recovery. IVCD (P = .001) and myocarditis (P = .016) were independent predictors of the composite end point of death, LV assist device placement, and/or transplant at 1 year. Those with an IVCD had a significantly lower 1-year survival than those without (P = .007). Conclusions Patients with a smaller LV end-diastolic diameter, higher cardiac index, and lack of IVCD at presentation for acute-onset HF were more likely to have LVEF recovery. IVCD was a poor prognostic marker in all patients presenting with acute cardiomyopathy.",
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AU - Ahmed, Haitham M.

AU - Rao, Shaline

AU - Dunn, Justin M.

AU - Harrington, Colleen

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AU - Russell, Stuart D.

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N2 - Background About one-third of patients with unexplained acute-onset heart failure (HF) recover left ventricular (LV) function; however, characterization of these patients in the setting of contemporary HF therapies is limited. We aim to describe baseline characteristics and predictors of recovery in patients with acute-onset cardiomyopathy. Methods We previously described 851 patients with unexplained HF undergoing endomyocardial biopsy. In this study, 235 patients with acute-onset HF were further retrospectively examined. Results Follow-up LV ejection fraction (LVEF) was available for 138 patients. At 1 year, 48 of 138 (33%) had LVEF recovery (follow-up LVEF ≥50%), and 90 of 138 (65%) had incomplete or lack of recovery. Higher cardiac index (P = .019), smaller LV diastolic diameter (P = .002), and lack of an intraventricular conduction delay (IVCD) (P = .002) were associated with LVEF recovery. IVCD (P = .001) and myocarditis (P = .016) were independent predictors of the composite end point of death, LV assist device placement, and/or transplant at 1 year. Those with an IVCD had a significantly lower 1-year survival than those without (P = .007). Conclusions Patients with a smaller LV end-diastolic diameter, higher cardiac index, and lack of IVCD at presentation for acute-onset HF were more likely to have LVEF recovery. IVCD was a poor prognostic marker in all patients presenting with acute cardiomyopathy.

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