LAUSR

Patients with new-onset heart failure (HF) usually undergo rigorous testing to identify the underlying cause and correct modifiable conditions such as coronary artery disease. Often, these patients present with dilated left ventricles and reduced ejection fraction. A large proportion of these patients have no modifiable factors and are therefore coined to have idiopathic dilated cardiomyopathy (DCM). This group is still very heterogeneous with different aetiologies including genetic causes. Response to treatment and spontaneous recovery is variable and difficult to predict. In this issue of the Journal, Tayal et al.1 present their results employing cardiac magnetic resonance imaging (CMR) combined with dobutamine stress testing to improve prediction of left ventricular (LV) functional recovery. They included 34 patients with recent-onset DCM, most of which had substantial improvement of LV function after 12-month follow-up. In addition to female sex, the study demonstrates that contractile reserve measured by dobutamine stress CMR predicts functional recovery. Is seems that there is spontaneous recovery in many patients presenting with new-onset LV dysfunction. All but a small subset of patients with unbearable side effects or unwillingness to adhere to pharmacological therapy, however, are treated with HF medication including angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, beta-adrenergic receptor blockers and mineralocorticoid receptor antagonists. A recent randomized study has investigated if it is safe to withdraw this medication after LV recovery in DCM patients. The TRED-HF study has demonstrated that removal of HF medication leads to recurrence of LV dysfunction in many patients and ‘spontaneous’ improvement is actually HF remission induced by medication and not recovery.2 As reverse remodelling is not only closely related to exercise capacity and HF functional class but also reduction of HF hospitalizations and