Baseline Blood Pressure and Left Ventricular Reverse Remodeling in Dilated Cardiomyopathy with Spontaneous Mechanical Alternans

Objective Spontaneous mechanical alternans (MA), or pulsus alternans, has been observed in heart failure patients with hypertension or tachycardia for 150 years and is considered a sign of a poor prognosis. How-ever, in some dilated cardiomyopathy (DCM) patients with MA, optimal medical therapy (OMT) brings left ventricular reverse remodeling (LVRR), a preferable prognostic indicator. This study examined the probability of LVRR in DCM patients with spontaneous MA and whether or not LVRR can be predicted by the baseline blood pressure or heart rate.Methods We conducted a single-center, retrospective observational study of newly diagnosed DCM patients from January 2017 to December 2020.Results Thirty-three newly diagnosed DCM patients were retrospectively examined. Spontaneous MA was observed during diagnostic cardiac catheterization in at least 1 of the pressure waveforms of the aorta, left ventricle, pulmonary artery, or right ventricle in 10 patients (30%) (MA-group). LVRR after OMT was achieved roughly equally in the MA group (6 of 10, 60%) and the non-MA group (12 of 23, 52%). In the MA group, those who achieved LVRR had a significantly higher baseline systolic aortic pressure (more than 120 mmHg in all 6 patients) than those who did not, although the baseline heart rate did not show a signifi-cant correlation with LVRR. In contrast, in the non-MA group, LVRR was unrelated to the baseline aortic pressure or heart rate.Conclusion The probability of LVRR in newly-diagnosed DCM patients with spontaneous MA was similar to that in those without spontaneous MA. Spontaneous MA may not necessarily be a sign of a poor progno-sis if observed in patients with a preserved blood pressure.

Automated summary

This study examined the predictability of left ventricular reverse remodeling (LVRR) in newly diagnosed dilated cardiomyopathy (DCM) patients with spontaneous mechanical alternans (MA). The study found that the probability of LVRR after optimal medical therapy (OMT) was similar in DCM patients with and without spontaneous MA. In the MA group, patients who achieved LVRR had significantly higher baseline systolic aortic pressure, while the baseline heart rate did not show a significant correlation with LVRR. In contrast, LVRR in the non-MA group was unrelated to the baseline aortic pressure or heart rate.