Objective Patients with non-ischaemic dilated cardiomyopathy (NICM) may experience a normalisation in left ventricular ejection fraction (LVEF). Although this correlates with improved prognosis, it does not correspond to a normalisation in the risk of death during follow-up. Currently, there are no tools to risk stratify this population. We tested the hypothesis that absolute global longitudinal strain (aGLS) is associated with mortality in patients with NICM and recovered ejection fraction (LVEF). Methods We designed a retrospective, international, longitudinal cohort study enrolling patients with NICM with LVEF <40% improved to the normal range (>50%). We studied the relationship between aGLS measured at the time of the first recording of a normalised LVEF and all-cause mortality during follow-up. We considered aGLS >18% as normal and aGLS ≥16% as of potential prognostic value. Results 206 patients met inclusion criteria. Median age was 53.5 years (IQR 44.3–62.8) and 56.6% were males. LVEF at diagnosis was 32.0% (IQR 24.0–38.8). LVEF at the time of recovery was 55.0% (IQR 51.7–60.0). aGLS at the time of LVEF recovery was 13.6%±3.9%. 166 (80%) and 141 (68%) patients had aGLS ≤18% and <16%, respectively. During a follow-up of 5.5±2.8 years, 35 patients (17%) died. aGLS at the time of first recording of a recovered LVEF correlated with mortality during follow-up (HR 0.90, 95% CI 0.91 to 0.99, p=0.048 in adjusted Cox model). No deaths were observed in patients with normal aGLS (>18%). In unadjusted Kaplan-Meier survival analysis, aGLS <16% was associated with higher mortality during follow-up (31 deaths (22%) in patients with GLS <16% vs 4 deaths (6.2%) in patients with GLS ≥16%, HR 3.2, 95% CI 1.1 to 9, p=0.03). Conclusions In patients with NICM and normalised LVEF, an impaired aGLS at the time of LVEF recovery is frequent and associated with worse outcomes. Data are available upon reasonable request.

中文翻译：

---

纵向应变对射血分数恢复的扩张型心肌病的预后意义

目的非缺血性扩张型心肌病 (NICM) 患者的左心室射血分数 (LVEF) 可能会正常化。尽管这与改善预后相关，但它并不对应于随访期间死亡风险的正常化。目前，没有工具可以对这一人群进行风险分层。我们检验了绝对全局纵向应变 (aGLS) 与 NICM 患者死亡率和射血分数恢复 (LVEF) 相关的假设。方法 我们设计了一项回顾性国际纵向队列研究，纳入 LVEF <40% 改善至正常范围 (>50%) 的 NICM 患者。我们研究了在第一次记录标准化 LVEF 时测量的 aGLS 与随访期间的全因死亡率之间的关系。我们考虑了 aGLS > 18% 正常，aGLS ≥16% 作为潜在预后价值。结果 206 例患者符合纳入标准。中位年龄为 53.5 岁（IQR 44.3-62.8），56.6% 为男性。诊断时的 LVEF 为 32.0% (IQR 24.0–38.8)。恢复时的 LVEF 为 55.0% (IQR 51.7–60.0)。LVEF 恢复时的 aGLS 为 13.6%±3.9%。166 名 (80%) 和 141 名 (68%) 患者的 aGLS 分别≤18% 和 <16%。在 5.5±2.8 年的随访期间，35 名患者 (17%) 死亡。首次记录恢复的 LVEF 时的 aGLS 与随访期间的死亡率相关（HR 0.90，95% CI 0.91 至 0.99，调整后的 Cox 模型中 p=0.048）。在 aGLS 正常的患者中未观察到死亡 (>18%)。在未经调整的 Kaplan-Meier 生存分析中，aGLS <16% 与随访期间较高的死亡率相关（GLS <16% 的患者中有 31 例死亡（22%）对 4 例死亡（6. 2%）在 GLS ≥16%、HR 3.2、95% CI 1.1 至 9 的患者中，p=0.03）。结论 在 NICM 和 LVEF 正常化的患者中，LVEF 恢复时 aGLS 受损是常见的，并且与较差的结果相关。可根据合理要求提供数据。