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@article{Halliday:2021:10.1002/ejhf.2063,
author = {Halliday, B and Owen, R and Gregson, J and Vassiliou, V and Chen, X and Wage, R and Lota, A and Khalique, Z and Tayal, U and Hammersley, D and Jones, R and Baksi, A and Cowie, M and Cleland, J and Pennell, D and Prasad, S},
doi = {10.1002/ejhf.2063},
journal = {European Journal of Heart Failure},
pages = {293--301},
title = {Myocardial remodelling after withdrawing therapy for heart failure in patients with recovered dilated cardiomyopathy: insights from TRED-HF},
url = {http://dx.doi.org/10.1002/ejhf.2063},
volume = {23},
year = {2021}
}

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TY  - JOUR
AB  - Aims: To characterize adverse ventricular remodelling after withdrawing therapy in recovered dilated cardiomyopathy (DCM). Methods and results: TRED-HF was a randomized controlled trial with a follow-on single-arm cross-over phase that examined the safety and feasibility of therapy withdrawal in patients with recovered DCM over 6 months. The primary endpoint was relapse of heart failure defined by (i) a reduction in left ventricular (LV) ejection fraction >10% and to <50%, (ii) >10% increase in LV end-diastolic volume and to above the normal range, (iii) a twofold rise in N-terminal pro-B-type natriuretic peptide and to >400 ng/L, or (iv) evidence of heart failure. LV mass, LV and right ventricular (RV) global longitudinal strain (GLS) and extracellular volume were measured using cardiovascular magnetic resonance at baseline and follow-up (6 months or relapse) for 48 patients. LV cell and extracellular matrix masses were derived. The effect of withdrawing therapy, stratified by relapse and genotype, was investigated in the randomized and follow-on phases. In the randomized comparison, withdrawing therapy led to an increase in mean LV mass [5.4 g/m2; 95% confidence interval (CI) 1.3–9.5] and cell mass (4.2 g/m2; 95% CI 0.5–8.0) and a reduction in LV (3.5; 95% CI 1.6–5.5) and RV (2.4; 95% CI 0.1–4.7) GLS. In a non-randomized comparison of all patients (n = 47) who had therapy withdrawn in either phase, there was an increase in LV mass (6.2 g/m2; 95% CI 3.6–8.9; P = 0.0001), cell mass (4.0 g/m2; 95% CI 1.8–6.2; P = 0.0007) and matrix mass (1.7 g/m2; 95% CI 0.7–2.6; P = 0.001) and a reduction in LV GLS (2.7; 95% CI 1.5–4.0; P = 0.0001). Amongst those who had therapy withdrawn and did not relapse, similar changes were observed (n = 28; LV mass: 5.1 g/m2, 95% CI 1.5–8.8, P = 0.007; cell mass: 3.7 g/m2, 95% CI 0.3–7.0, P = 0.03; matrix mass: 1.7 g/m2, 95% CI 0.4–3.0, P = 0.02; LV GLS: 1.7, 95% CI
AU  - Halliday,B
AU  - Owen,R
AU  - Gregson,J
AU  - Vassiliou,V
AU  - Chen,X
AU  - Wage,R
AU  - Lota,A
AU  - Khalique,Z
AU  - Tayal,U
AU  - Hammersley,D
AU  - Jones,R
AU  - Baksi,A
AU  - Cowie,M
AU  - Cleland,J
AU  - Pennell,D
AU  - Prasad,S
DO  - 10.1002/ejhf.2063
EP  - 301
PY  - 2021///
SN  - 1388-9842
SP  - 293
TI  - Myocardial remodelling after withdrawing therapy for heart failure in patients with recovered dilated cardiomyopathy: insights from TRED-HF
T2  - European Journal of Heart Failure
UR  - http://dx.doi.org/10.1002/ejhf.2063
UR  - https://onlinelibrary.wiley.com/doi/10.1002/ejhf.2063
UR  - http://hdl.handle.net/10044/1/85878
VL  - 23
ER  -

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