비 허혈성 가역성 좌심부전 환자의 임상적 경과 및 영향 요인

Abstract

Background and Objectives：About 25% of the patients with non-ischemic left ventricular (LV) systolic dysfunction will improve spontaneously. However, little has been known about the fate of the patients stricken with heart failure after recovery from LV dysfunction. We hypothesized that the patients who recovered from non-ischemic LV dysfunction have a substantial risk for recurrent heart failure.

Subjects and Methods：Fifty patients (32 males, mean age: 54.9±12.4 years) who recovered from systolic heart failure (LV ejection fraction; an EF of 28.8±7.2% at the initial presentation) to near-normal (LVEF >40% and a 10% or more increase in the absolute value) were monitored for the recurrence of heart failure. Patients with significant coronary artery disease were excluded. The etiologies of heart failure were idiopathic dilated cardiomyopathy (n=39), alcoholic cardiomyopathy (n=7), adriamycin-induced cardiomyopathy (n=2), and tachycardia-induced cardiomyopathy (n=2). After recovery of LV dysfunction, the patients were followed up for a mean of 41.0±26.3 months.

Results：In 9 patients (18%), the LV systolic dysfunction recurred during follow-up (LVEF 32.6±7.3%). There was no significant difference in the baseline clinical and echocardiographic variables between the patients with and without recurrent heart failure. However, cessation of anti-heart failure medication was more frequently observed in the patients with recurrent LV systolic dysfunction (55.6% vs 4.9%, respectively, p<0.05).

Conclusion：Recurrent heart failure may ensue in the patients with reversible non-ischemic LV systolic dysfunction. The maintenance of anti-heart failure medication in these patients may be a significant influencing factor for their clinical prognosis.