Discussion:
Our study included 100 patients 45 patients completed follow up 3-6
months (90-180 Days) and 20 died .70% of the patients were of ischemic
etiology 15% underwent complete revascularization while the rest
continue follow up. 12(26%) patients showed RR after revascularization
and 21(46%) patients showed RR followed medical treatment with Q
Minnesota questionnaire of heart value of P value significance
<0.001 .and Heart rate changed from mean 93±19.4 to
82.8±30.1beats per minute with significant p value
<0.007.Change of MR 1.4± 2.8 to 1.2± 2.7 with P value 0.127(
it was not statistically significant), ejection fraction 30.6 ±8.5 to
mean41.9±14.0 with P value <0.001 and ESV index from 50.5±21.1
to 37.5±23.2 with p value 0.017 and Global longitudinal strain mean
value 5.9±3.5 to 7.5±3.8 with P value 0.024,. The right side dimensions
of end-systolic showed a significant increase from 9.8±4.5 to 8.2 ±3.4
with P value 0.008 .FAC showed a significant increase from a mean of
41.7±10.7 to 45.4 ±8.8 with P value of 0.008 .
100 new onset heart failure patients were included with 45 underwent
follow up ,33 showed reverse remodeling and 20patients died ,Troponin I
was statistically significant with mean 1.8±4.9 to 0.1±0.3 with P value
<0.001 for patients with ejection fraction 30.6 ±8.5 to
mean41.9±14.0 with P value <0.001, Troponin I change mean 0.15
±0.2 to 0.13 ±0.2 among group 1 and 3 respectively with P value 0.710.
These values showed the significant in cardiac troponin and its
affection by reverse remodeling of the heart failure patients with
improvement in ejection fraction and reduction of volume of LV cavity .
Right ventricular function has a dichotomous role. At diagnosis
it is an important prognostic marker in DCM(5,7) .
Interestingly, it frequently shows a rapid recovery under therapy (up to
6 months). Right ventricular function normalization is part of a global
hemodynamic improvement induced by therapy and precedes LVRR. It is
emerging as an early therapeutic target and an independent prognostic
predictor (5). Improvement in right ventricular
function is also described in CRT implanted patients, probably due to a
hemodynamic improvement very early after resynchronization, and it is
associated with an improvement in survival rates(6).
Conversely, the development of right ventricular dysfunction during
follow-up is an expression of structural progression of the disease and
portends a negative outcome (5).
From 1993 to 2008, we analyzed 512 patients with DCM (46 years
of age [36 to 55 years of age], left ventricular ejection fraction
32% [25% to 41%]) with a potential follow-up of ≥72 months and
available data at baseline and at least 1 pre-specified follow-up
evaluation (i.e., 6, 24, 48, or 72 months). RV dysfunction was defined
as RV fractional area change <35% at 2-dimensional
echocardiography. The primary outcome measure was a composite of death
or heart transplantation.
At enrollment, 103 (20%) patients had RV dysfunction. During follow-up,
89 of them (86%, 17% of the overall cohort) normalized RVF at a median
time of 6 months, whereas 38 of the remaining 409 patients with normal
baseline RVF (9%; 7% of the overall population) exhibited a new-onset
RV dysfunction (median time: 36 months). RVF normalization was
significantly associated with subsequent left ventricular reverse
remodeling that was observed at a median time of 24 months (odds ratio:
2.49; 95% confidence interval [CI]: 1.17 to 5.3; p = 0.018). At
baseline multivariate analysis, RV dysfunction was independently
associated with the primary outcome measure (hazard ratio: 1.71; 95%
CI: 1.02 to 2.85; p = 0.0413). At time-dependent model, RVF revaluation
over time maintained an independent predictive value (hazard ratio:
2.83; 95% CI: 1.57 to 5.11; p = 0.0006).