Prevalence and Clinical Characteristics of Nondilated Cardiomyopathy and the Effect of Atrial Fibrillation

The treatment of patients with chronic heart failure and those with asymptomatic left ventricular (LV) dysfunction has focused primarily on patients with LV enlargement and a low ejection fraction (EF). Little attention has been paid to those with a normal chamber size and a low EF. We sought to examine the LV geometry and clinical characteristics in such patients with nondilated cardiomyopathy. Of 3,350 transthoracic echocardiograms performed during a 6-month period, 696 showed an EF of ≤0.45. The patients with an end-diastolic diameter of >56 mm, regional wall motion abnormalities, or valvular disease were excluded. Of the 696 patients, 98 met these criteria, and their medical records were reviewed. The average age was 71 ± 14 years, and 56% were men. Common co-morbidities included hypertension in 52% and atrial fibrillation (AF) in 43%. Only 22% had disabling cardiac symptoms (functional class III or greater). The average end-diastolic dimension was 49 ± 5 mm, and the EF was 34 ± 8%. LV hypertrophic remodeling was present in 53%. A second echocardiogram (422 ± 177 days after the baseline study) was available for 54 patients. The chamber size was unchanged, but the EF had increased from 33 ± 8% to 40 ± 14% (p <0.01). The improvement in EF was seen in the group with AF (33 ± 6% to 44 ± 15%, p <0.01) but not in those with normal sinus rhythm (33 ± 9% to 37 ± 12%, p = NS). In conclusion, 14% of patients with an EF of ≤0.45 had nondilated cardiomyopathy, often with LV hypertrophic remodeling and/or AF. An improvement in LV function can be expected in many patients with nondilated cardiomyopathy, particularly those with AF.