LAUSR

Left ventricular reverse remodelling (LVRR) has been validated as a key prognostic tool in dilated cardiomyopathy (DCM).1,2 However, it has been described that LVRR may take up to 2 years following diagnosis.1 Therefore, new parameters are advocated in order to improve prognostication of DCM patients. The time course and the possible prognostic benefit of therapy-induced changes in echo-Doppler diastolic and haemodynamic parameters are currently unknown. All DCM patients consecutively enrolled in the Trieste Heart Muscle Disease Registry1 from 2005 to 2015 were retrospectively analysed. We considered as the outcome measure a composite of death or heart transplant (D/HT). After enrolment, patients received tailored evidence-based therapies. All patients enrolled had to have a 6-month (interquartile range 4–9) evaluation. LVRR was defined as a left ventricular ejection fraction increase ≥ 10 points or ≥ 50% if associated with an end-diastolic diameter reduction ≥10% or ≤ 33 mm/m2.1 The integrated echo-Doppler haemodynamic and diastolic evaluation was systematically performed according to international guidelines and considered the following: (i) significant mitral regurgitation: grade ≥ 2; (ii) right ventricular dysfunction (RVD): right ventricular fractional area change < 35%; (iii) left atrial (LA) end-systolic enlargement: LA endsystolic area >13 cm/m2; (iv) left ventricular restrictive filling pattern (LVRFP): E-wave deceleration time < 120 ms or E/A ratio ≥ 2 associated with E-wave deceleration time ≤150 ms; (v) septal E/E’ ratio >15.3,4 For all abovementioned parameters, the intra-class correlation coefficient for interand intraobserver reproducibility were ≥ 0.90 and ≥ 0.95, respectively (all P< 0.001). The study population included 275 DCM patients (median duration of symptoms