Changes in clinical and imaging variables during withdrawal of heart failure therapy in recovered dilated cardiomyopathy
Abstract Aims This study aimed to profile the changes in non‐invasive clinical, biochemical, and imaging markers during withdrawal of therapy in patients with recovered dilated cardiomyopathy, providing insights into the pathophysiology of relapse. Methods and results Clinical, biochemical, and imag...
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| Format: | Article |
| Language: | English |
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Wiley
2022-06-01
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| Series: | ESC Heart Failure |
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| Online Access: | https://doi.org/10.1002/ehf2.13872 |
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| author | Brian P. Halliday Ruth Owen John Gregson Ali Vazir Rebecca Wassall Zohya Khalique Amrit S. Lota Upasana Tayal Daniel J. Hammersley Richard E. Jones Dudley J. Pennell Martin R. Cowie John G.F. Cleland Sanjay K. Prasad |
| author_facet | Brian P. Halliday Ruth Owen John Gregson Ali Vazir Rebecca Wassall Zohya Khalique Amrit S. Lota Upasana Tayal Daniel J. Hammersley Richard E. Jones Dudley J. Pennell Martin R. Cowie John G.F. Cleland Sanjay K. Prasad |
| author_sort | Brian P. Halliday |
| collection | DOAJ |
| description | Abstract Aims This study aimed to profile the changes in non‐invasive clinical, biochemical, and imaging markers during withdrawal of therapy in patients with recovered dilated cardiomyopathy, providing insights into the pathophysiology of relapse. Methods and results Clinical, biochemical, and imaging data from patients during phased withdrawal of therapy in the randomized or single‐arm cross‐over phases of TRED‐HF were profiled. Clinical variables were measured at each study visit and imaging variables were measured at baseline, 16 weeks, and 6 months. Amongst the 49 patients [35% women, mean age 53.6 years (standard deviation 11.6)] who withdrew therapy, 20 relapsed. Increases in mean heart rate [7.6 beats per minute (95% confidence interval, CI, 4.5, 10.7)], systolic blood pressure [6.6 mmHg (95% CI 2.7, 10.5)], and diastolic blood pressure [5.8 mmHg (95% CI 3.1, 8.5)] were observed within 4–8 weeks of starting to withdraw therapy. A rise in mean left ventricular (LV) mass [5.1 g/m2 (95% CI 2.8, 7.3)] and LV end‐diastolic volume [3.9 mL/m2 (95% CI 1.1, 6.7)] and a reduction in mean LV ejection fraction [−4.2 (95% CI −6.6, −1.8)] were seen by 16 weeks, the earliest imaging follow‐up. Plasma N‐terminal pro‐brain natriuretic peptide (NT‐proBNP) fell immediately after withdrawing beta‐blockers and only tended to increase 6 months after beginning therapy withdrawal [mean change in log NT‐proBNP at 6 months: 0.2 (95% CI −0.1, 0.4)]. Conclusions Changes in plasma NT‐proBNP are a late feature of relapse, often months after a reduction in LV function. A rise in heart rate and blood pressure is observed soon after withdrawing therapy in recovered dilated cardiomyopathy, typically accompanied or closely followed by early changes in LV structure and function. |
| format | Article |
| id | doaj-art-4b4a9c4d835046cf978ac1a1f29a6654 |
| institution | Kabale University |
| issn | 2055-5822 |
| language | English |
| publishDate | 2022-06-01 |
| publisher | Wiley |
| record_format | Article |
| series | ESC Heart Failure |
| spelling | doaj-art-4b4a9c4d835046cf978ac1a1f29a66542025-02-05T05:22:10ZengWileyESC Heart Failure2055-58222022-06-01931616162410.1002/ehf2.13872Changes in clinical and imaging variables during withdrawal of heart failure therapy in recovered dilated cardiomyopathyBrian P. Halliday0Ruth Owen1John Gregson2Ali Vazir3Rebecca Wassall4Zohya Khalique5Amrit S. Lota6Upasana Tayal7Daniel J. Hammersley8Richard E. Jones9Dudley J. Pennell10Martin R. Cowie11John G.F. Cleland12Sanjay K. Prasad13Cardiovascular Research Centre, Royal Brompton Hospital, Guy's and St Thomas' NHS Trust and National Heart Lung Institute Imperial College London SW3 6NP UKDepartment of Medical Statistics London School of Hygiene and Tropical Medicine London UKDepartment of Medical Statistics London School of Hygiene and Tropical Medicine London UKCardiovascular Research Centre, Royal Brompton Hospital, Guy's and St Thomas' NHS Trust and National Heart Lung Institute Imperial College London SW3 6NP UKCardiovascular Research Centre, Royal Brompton Hospital, Guy's and St Thomas' NHS Trust and National Heart Lung Institute Imperial College London SW3 6NP UKCardiovascular Research Centre, Royal Brompton Hospital, Guy's and St Thomas' NHS Trust and National Heart Lung Institute Imperial College London SW3 6NP UKCardiovascular Research Centre, Royal Brompton Hospital, Guy's and St Thomas' NHS Trust and National Heart Lung Institute Imperial College London SW3 6NP UKCardiovascular Research Centre, Royal Brompton Hospital, Guy's and St Thomas' NHS Trust and National Heart Lung Institute Imperial College London SW3 6NP UKCardiovascular Research Centre, Royal Brompton Hospital, Guy's and St Thomas' NHS Trust and National Heart Lung Institute Imperial College London SW3 6NP UKCardiovascular Research Centre, Royal Brompton Hospital, Guy's and St Thomas' NHS Trust and National Heart Lung Institute Imperial College London SW3 6NP UKCardiovascular Research Centre, Royal Brompton Hospital, Guy's and St Thomas' NHS Trust and National Heart Lung Institute Imperial College London SW3 6NP UKCardiovascular Research Centre, Royal Brompton Hospital, Guy's and St Thomas' NHS Trust and National Heart Lung Institute Imperial College London SW3 6NP UKCardiovascular Research Centre, Royal Brompton Hospital, Guy's and St Thomas' NHS Trust and National Heart Lung Institute Imperial College London SW3 6NP UKCardiovascular Research Centre, Royal Brompton Hospital, Guy's and St Thomas' NHS Trust and National Heart Lung Institute Imperial College London SW3 6NP UKAbstract Aims This study aimed to profile the changes in non‐invasive clinical, biochemical, and imaging markers during withdrawal of therapy in patients with recovered dilated cardiomyopathy, providing insights into the pathophysiology of relapse. Methods and results Clinical, biochemical, and imaging data from patients during phased withdrawal of therapy in the randomized or single‐arm cross‐over phases of TRED‐HF were profiled. Clinical variables were measured at each study visit and imaging variables were measured at baseline, 16 weeks, and 6 months. Amongst the 49 patients [35% women, mean age 53.6 years (standard deviation 11.6)] who withdrew therapy, 20 relapsed. Increases in mean heart rate [7.6 beats per minute (95% confidence interval, CI, 4.5, 10.7)], systolic blood pressure [6.6 mmHg (95% CI 2.7, 10.5)], and diastolic blood pressure [5.8 mmHg (95% CI 3.1, 8.5)] were observed within 4–8 weeks of starting to withdraw therapy. A rise in mean left ventricular (LV) mass [5.1 g/m2 (95% CI 2.8, 7.3)] and LV end‐diastolic volume [3.9 mL/m2 (95% CI 1.1, 6.7)] and a reduction in mean LV ejection fraction [−4.2 (95% CI −6.6, −1.8)] were seen by 16 weeks, the earliest imaging follow‐up. Plasma N‐terminal pro‐brain natriuretic peptide (NT‐proBNP) fell immediately after withdrawing beta‐blockers and only tended to increase 6 months after beginning therapy withdrawal [mean change in log NT‐proBNP at 6 months: 0.2 (95% CI −0.1, 0.4)]. Conclusions Changes in plasma NT‐proBNP are a late feature of relapse, often months after a reduction in LV function. A rise in heart rate and blood pressure is observed soon after withdrawing therapy in recovered dilated cardiomyopathy, typically accompanied or closely followed by early changes in LV structure and function.https://doi.org/10.1002/ehf2.13872Dilated cardiomyopathyMyocardial recoveryRemissionRemodelling |
| spellingShingle | Brian P. Halliday Ruth Owen John Gregson Ali Vazir Rebecca Wassall Zohya Khalique Amrit S. Lota Upasana Tayal Daniel J. Hammersley Richard E. Jones Dudley J. Pennell Martin R. Cowie John G.F. Cleland Sanjay K. Prasad Changes in clinical and imaging variables during withdrawal of heart failure therapy in recovered dilated cardiomyopathy ESC Heart Failure Dilated cardiomyopathy Myocardial recovery Remission Remodelling |
| title | Changes in clinical and imaging variables during withdrawal of heart failure therapy in recovered dilated cardiomyopathy |
| title_full | Changes in clinical and imaging variables during withdrawal of heart failure therapy in recovered dilated cardiomyopathy |
| title_fullStr | Changes in clinical and imaging variables during withdrawal of heart failure therapy in recovered dilated cardiomyopathy |
| title_full_unstemmed | Changes in clinical and imaging variables during withdrawal of heart failure therapy in recovered dilated cardiomyopathy |
| title_short | Changes in clinical and imaging variables during withdrawal of heart failure therapy in recovered dilated cardiomyopathy |
| title_sort | changes in clinical and imaging variables during withdrawal of heart failure therapy in recovered dilated cardiomyopathy |
| topic | Dilated cardiomyopathy Myocardial recovery Remission Remodelling |
| url | https://doi.org/10.1002/ehf2.13872 |
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