Improvement of left ventricular systolic function in inflammatory cardiomyopathy: What plays a role?
2016
Aims. To compare the differences between patients with
inflammatory cardiomyopathy (ICM) with and without improvement
in left ventricular (LV) systolic function and to identify the
relevant predictors of LV improvement. Patients and Methods.
The study included 63 patients with biopsy-proven ICM and heart
failure symptoms of at least NYHA II, symptom duration <= 6
months, LV ejection fraction (LVEF) <= 40% assessed by
echocardiography and presence of >14 mononuclear leukocytes
(LCA+ cells)/mm2 in biopsy samples. Patients were evaluated at
baseline and after 6 months. Results. In the group with LVEF
improvement of >= 10% (I+ group, n = 41), LVEF increased from
24 ± 7% to 47 ± 8% (P < 0.001). In 22 patients (group I-),
there was no or minimal LVEF increase (< 10%). In the I+ group,
there were more LCA+ cells/mm2 at baseline (25.1 ± 16.5 vs.
18.5 ± 4.4 cells/mm2; P = 0.032) and a more significant
decrease in LCA+ cells in the follow-up (reduction of 13.6 ±
14.3 cells/mm2 vs. 5.0 ± 7.7 cells/mm2 in the I- group; P =
0.009). The univariate logistic regression showed a possible
association of number of LCA+ cells, LV end-diastolic diameter
and N-terminal fragment of pro-brain natriuretic peptide
(NTproBNP) value with LVEF improvement. In the multivariate
analysis, only NTproBNP at diagnosis was confirmed as an
independent predictor of LVEF improvement (OR=1.2; 1.003 to
1.394; P = 0.046). Conclusion. The LV systolic function
improvement was observed in 65% of the patients. In these
patients, the number of inflammatory cells at baseline was
higher and decreased more but the higher baseline NTproBNP
value was the only independent predictor of LVEF improvement.
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