Heart and Vessels

, Volume 34, Issue 1, pp 95–103 | Cite as

Dilated cardiomyopathy with re-worsening left ventricular ejection fraction

  • Takeru NabetaEmail author
  • Takayuki Inomata
  • Shunsuke Ishii
  • Mayu Yazaki
  • Teppei Fujita
  • Yuichiro Iida
  • Yuki Ikeda
  • Emi Maekawa
  • Takashi Naruke
  • Toshimi Koitabashi
  • Junya Ako
Original Article


Re-worsening left ventricular ejection fraction (LVEF) is observed in some patients with dilated cardiomyopathy (DCM) despite initial improvements in LVEF. We analyzed cardiac outcomes and clinical variables associated with this re-worsening LVEF. A total of 180 newly diagnosed DCM patients who received only pharmacotherapy were enrolled. Echocardiography was performed after 6, 12, 24, and 36 months after initiation of pharmacotherapy. Patients were divided into three groups: (1) Improved: (n = 113, 63%), defined as those > 10% increase in LVEF after 12 months and no decrease (> 10%) between 12 and 36 months; (2) Re-worse: (n = 12, 7%), those with > 10% increase in LVEF after 12 months but with decrease (> 10%) between 12 and 36 months; and (3) Not-improved: (n = 55: 30%), those with no increase in LVEF (> 10%) after 12 months. Patients with re-worse group were older (P = 0.04) and had higher brain natriuretic peptide (BNP) levels after 12 months (P = 0.002) than those in the Improved group. Major cardiac events (sudden death, implantation of a ventricular assist device, and death due to heart failure,) were observed in 13 (7%) patients after 36 months of pharmacotherapy. Multivariate analysis revealed that the Re-worse group had a higher risk for cardiac events (hazard ratio 11.7, 95% confidence interval 1.9–90.7, P = 0.01) than the Improved group, but had a similar risk compared with the Not-improved group. Re-worsening LVEF was associated with poor cardiac outcomes in newly diagnosed DCM patients. Age and persistently high-BNP levels after improvement in LVEF were significantly associated with re-worsening LVEF.


Heart failure Dilated cardiomyopathy Left ventricular ejection fraction Recovered ejection fraction 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no competing interests.

Supplementary material

380_2018_1214_MOESM1_ESM.docx (22 kb)
Supplementary material 1 (DOCX 22 kb)


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Copyright information

© Springer Japan KK, part of Springer Nature 2018

Authors and Affiliations

  • Takeru Nabeta
    • 1
    Email author
  • Takayuki Inomata
    • 2
  • Shunsuke Ishii
    • 1
  • Mayu Yazaki
    • 1
  • Teppei Fujita
    • 1
  • Yuichiro Iida
    • 1
  • Yuki Ikeda
    • 1
  • Emi Maekawa
    • 1
  • Takashi Naruke
    • 1
  • Toshimi Koitabashi
    • 1
  • Junya Ako
    • 1
  1. 1.Department of Cardiovascular MedicineKitasato University School of MedicineSagamiharaJapan
  2. 2.Department of Cardiovascular MedicineKitasato University School, Kitasato Institute HospitalTokyoJapan

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