Persistent recovery of normal left ventricular function and dimension in idiopathic dilated cardiomyopathy during long‐term follow‐up: does real healing exist?

Background: an important number of patients with idiopathic dilated cardiomyopathy have dramatically improved left ventricular function with optimal treatment; however,little is known about the evolution and long-term outcome of this subgroup,which shows apparent healing. this study assesses whether real healing actually exists in dilated cardiomyopathy.methods and results: persistent apparent healing was evaluated among 408 patients with dilated cardiomyopathy receiving tailored medical treatment and followed over the very long-term. persistent apparent healing was defined as left ventricular ejection fraction ≥50% and indexed left ventricular end-diastolic diameter ≤33 mm/m(2) at both mid-term (19±4 months) and long-term (103±9 months) follow-up. at mid-term,63 of 408 patients (15%) were apparently healed; 38 (60%; 9%of the whole population) showed persistent apparent healing at long-term evaluation. no predictors of persistent apparent healing were found. patients with persistent apparent healing showed better heart transplant–free survival at very long-term follow-up (95% versus 71%; p=0.014) compared with nonpersistently normalized patients. nevertheless,in the very longterm,37% of this subgroup experienced deterioration of left ventricular systolic function,and 5% died or had heart transplantation.conclusions: persistent long-term apparent healing was evident in a remarkable proportion of dilated cardiomyopathy patients receiving optimal medical treatment and was associated with stable normalization of main clinical and laboratory features. this condition can be characterized by a decline of left ventricular function over the very long term,highlighting the relevance of serial nd individualized follow-up in all patients with dilated cardiomyopathy,especially considering the absence of predictors for longterm apparent healing.