Background and Objectives:In some patients with non-ischemic cardiomyopathy, spontaneous improvement of left ventricular (LV) systolic dysfunction was reported. However, little has been known about the duration of anti-heart failure medication in patients with idiopathic dilated cardiomyopathy (IDCM) who recovered from LV systolic dysfunction. To investigate clinical course of IDCM patients who stopped the medication after improvement of LV systolic function, we followed clinical and echocardiographic data for 10 years. Subjects and Methods:174 patients diagnosed as IDCM at Asan Medical Center from September 1995 to January 2005 were investigated retrospectively (118 males, mean age: 56±14 years). LV ejection fraction (EF) was 26.1±11.0% at the initial presentation. Patients with significant coronary artery disease, thyroid disease, and dilated cardiomyopathy secondary to tachycardia, drug, or stress were excluded. The patients were followed up for a mean of 9.3 years. Improvement of LV systolic function was decided that LVEF recovered to near-normal EF >40% or more than 20% increase in the initial value. Results:Among 174 IDCM patients, 16 patient (9.2%) discontinued the anti-heart failure medications voluntarily or intentionally by clinician. When they were monitored for the recurrence of heart failure during the follow-up period, 3 patients (18.7%) developed LV systolic dysfunction. In the rest 158 patient who continued the medications, 65 patients (41.1%) had LV systolic dysfunction. There was no statistically difference in occurrence of LV systolic dysfunction between the patients with or without the discontinuation of medication (41.1% vs. 18.7%, p=0.107 with vs. without medication).
13 patients, who did not develop LV systolic dysfunction after recovery was composed of 11 males, mean age was 49±10 years. These patients’initial LVEF was 21.7±5.4% and they stopped medications when EF was improved to 51.2±16.8%. They were followed up for mean 4.8 years and still maintained LV systolic function. 3 patients who developed LV systolic dysfunction had improvement of LVEF was more than 20% of baseline but didn’t reach the normal LVEF(over 50%).Conclusion: The deterioration of LV systolic function in IDCM patients who discontinued anti-heart failure medication after recovery to near normal LVEF was comparable to that in patients who did not discontinued the medication. In addition, the degree of LV systolic function when recovered might be important for predicting the re-development of LV dysfunction hereafter. Therefore, the IDCM patient who’s LVEF was fully recovered after anti-heart failure medications might be considered to reduce or stop medications cautiously.
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