Arad Michael, Nussbaum Tamar, Blechman Ido, Feinberg Micha S, Koren-Morag Nira, Peled Yael, Freimark Dov
Isr Med Assoc J. 2014 Jul;16(7):405-11.
Contemporary therapiesimprove prognosis and may restore left ventricular (LV) sizeand function.
To examine the prevalence, clinical features and therapies associated with reverse remodeling (RR) in dilated cardiomyopathy (DCM).
The study group comprised 188 DCM patients who had undergone two echo examinations at least 6 months apart. RR was defined as increased LV ejection fraction (LVEF) by > or = 10% concomitant with > or = 10% decreased LV end-diastolic dimension.
RR occurred in 50 patients (26%) and was associated with significantly reduced end-systolic dimension, left atrial size, grade of mitral regurgitation, and pulmonary artery pressure. NYHA class improved in the SRR group. RR was less common in familial DCM and a long-standing disease and was more prevalent in patients with prior exposure to chemotherapy. Recent-onset disease, Iower initial LVEF and normal electrocardiogram were identified as independent predictors of RR. Beta-blocker dose wasrelated to improved LVEF but not to RR. Over a mean follow-up of 23 months, 16 patients (12%) from the 'no-RR' group died or underwent heart transplantation compared to none from the RR group (P < 0.01).
Contemporary therapies led to an an improvement in the condition of a considerable number of DCM patients. A period of close observation while optimizing medical therapy should be considered before deciding on invasive procedures.
当代疗法可改善预后，并可能恢复左心室（LV）大小和功能。
研究扩张型心肌病（DCM）患者中逆向重构（RR）的发生率、临床特征及相关治疗。
研究组包括188例DCM患者，他们接受了至少间隔6个月的两次超声心动图检查。RR定义为左心室射血分数（LVEF）增加≥10%，同时左心室舒张末期内径减少≥10%。
50例患者（26%）发生RR，且与收缩末期内径、左心房大小、二尖瓣反流程度和肺动脉压显著降低相关。RR组纽约心脏协会（NYHA）心功能分级改善。RR在家族性DCM和病程较长的疾病中较少见，在曾接受化疗的患者中更常见。新近发病、初始LVEF较低和心电图正常被确定为RR的独立预测因素。β受体阻滞剂剂量与LVEF改善有关，但与RR无关。平均随访23个月，“无RR”组有16例患者（12%）死亡或接受心脏移植，而RR组无1例（P<0.01）。
当代疗法使相当一部分DCM患者的病情得到改善。在决定采取侵入性治疗之前，应考虑在优化药物治疗的同时进行一段时间的密切观察。
