Chronic left ventricular failure in the community: Prevalence, prognosis, and predictors of the complete clinical recovery with return of cardiac size and function to normal in patients undergoing optimal therapy

Background: Chronic heart failure (CHF) is a progressive process requiring complex therapeutic interventions. Recently, several trials documented the clinical improvement and regression of left ventricular (LV) remodeling and function in patients on optimized CHF treatment. Furthermore, some authors reported isolated cases of patients who apparently "healed" from CHF. The aim of the present study was to characterize the phenomenon of the normalization in clinical status and LV size and function in CHF patients. Methods and Results: We monitored the clinical and echocardiographic parameters of a large cohort of patients with CHF and LV ejection fraction <40% every 6 months for a mean period of 17 +/- 9 months. Twenty of 110 study patients (18%) normalized clinical status and LV size and ejection fraction at any time (mean time 13 +/- 6 months) during the follow up. Such condition, however, was subsequently lost in 11 patients. The normalization was predicted by the nonischemic etiology of CHF, arterial hypertension, absence of diabetes mellitus, carvedilol therapy, and the dose of carvedilol. Conclusions: The normalization in clinical status and LV size and function is not infrequently observed in patients on optimal CHF therapy. It is predicted by a set of clinical variables and favored by beta-blocker therapy. At medium term, this condition fades in a significant portion of patients.