{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T15:40:18Z","timestamp":1790005218181,"version":"4.0.1"},"reference-count":23,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"17","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2019,9,3]]},"abstract":"\n Background<\/jats:title>\n \n Limited data are available on mid\u2010range ejection fraction (mr\n EF<\/jats:styled-content>\n ) patients with dilated cardiomyopathy. We sought to define the characteristics, evolution, and long\u2010term prognosis of dilated cardiomyopathy patients with mr\n EF<\/jats:styled-content>\n at diagnosis.\n <\/jats:p>\n <\/jats:sec>\n \n Methods and Results<\/jats:title>\n \n We analyzed all dilated cardiomyopathy patients consecutively evaluated in the Trieste Heart Muscle Disease Registry from 1988 to 2013. mr\n EF<\/jats:styled-content>\n and reduced ejection fraction (\n rEF<\/jats:styled-content>\n ) were defined as baseline left ventricular (\n LV<\/jats:styled-content>\n ) ejection fraction values between 40% and 49% and <40%, respectively. All\u2010cause mortality or heart transplantation, sudden cardiac death, or major ventricular arrhythmias were considered as outcome measures. Worsening LV ejection fraction (reduction to <40%) during follow\u2010up was also considered to identify possible predictors of adverse remodeling. Among 812 enrolled patients, 175 (22%) presented with mr\n EF<\/jats:styled-content>\n at presentation. At baseline, as compared with the\n rEF<\/jats:styled-content>\n group, mr\n EF<\/jats:styled-content>\n patients had lower rates of moderate\u2013severe mitral regurgitation and restrictive\n LV<\/jats:styled-content>\n filling pattern. During a median follow\u2010up period of 120 (60\u2013204) months, the mr\n EF<\/jats:styled-content>\n group presented a lower rate of death\/heart transplantation (9% versus 36%,\n P<\/jats:italic>\n <0.001) and sudden cardiac death or major ventricular arrhythmias (4.5% versus 15%,\n P<\/jats:italic>\n <0.001) than\n rEF<\/jats:styled-content>\n patients. Moreover, 29 out of 175 mr\n EF<\/jats:styled-content>\n patients (17%) evolved to\n rEF<\/jats:styled-content>\n . Restrictive\n LV<\/jats:styled-content>\n filling pattern emerged as the strongest predictor of\n rEF<\/jats:styled-content>\n development following multivariable analysis.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n \n mr\n EF<\/jats:styled-content>\n identified a consistent subgroup of dilated cardiomyopathy patients diagnosed in an earlier stage with subsequent apparent better long\u2010term evolution. However, 17% of these patients evolved into\n rEF<\/jats:styled-content>\n despite the use of medical therapy. A baseline restrictive\n LV<\/jats:styled-content>\n filling pattern was independently associated with subsequent evolution to\n rEF<\/jats:styled-content>\n .\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1161\/jaha.118.010705","type":"journal-article","created":{"date-parts":[[2019,8,21]],"date-time":"2019-08-21T09:04:36Z","timestamp":1566378276000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":13,"title":["Dilated Cardiomyopathy With Mid\u2010Range Ejection Fraction at Diagnosis: Characterization and Natural History"],"prefix":"10.1161","volume":"8","author":[{"given":"Piero","family":"Gentile","sequence":"first","affiliation":[{"name":"Cardiothoracic Department Azienda Sanitaria Universitaria Integrata di Trieste and University of Trieste Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Merlo","sequence":"additional","affiliation":[{"name":"Cardiothoracic Department Azienda Sanitaria Universitaria Integrata di Trieste and University of Trieste Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Cannat\u00e0","sequence":"additional","affiliation":[{"name":"Cardiothoracic Department Azienda Sanitaria Universitaria Integrata di Trieste and University of Trieste Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Gobbo","sequence":"additional","affiliation":[{"name":"Cardiothoracic Department Azienda Sanitaria Universitaria Integrata di Trieste and University of Trieste Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica","family":"Artico","sequence":"additional","affiliation":[{"name":"Cardiothoracic Department Azienda Sanitaria Universitaria Integrata di Trieste and University of Trieste Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Davide","family":"Stolfo","sequence":"additional","affiliation":[{"name":"Cardiothoracic Department Azienda Sanitaria Universitaria Integrata di Trieste and University of Trieste Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marta","family":"Gigli","sequence":"additional","affiliation":[{"name":"Cardiothoracic Department Azienda Sanitaria Universitaria Integrata di Trieste and University of Trieste Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Federica","family":"Ramani","sequence":"additional","affiliation":[{"name":"Cardiothoracic Department Azienda Sanitaria Universitaria Integrata di Trieste and University of Trieste Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giulia","family":"Barbati","sequence":"additional","affiliation":[{"name":"Biostatistics Unit Department of Medical Sciences University of Trieste Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bruno","family":"Pinamonti","sequence":"additional","affiliation":[{"name":"Cardiothoracic Department Azienda Sanitaria Universitaria Integrata di Trieste and University of Trieste Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gianfranco","family":"Sinagra","sequence":"additional","affiliation":[{"name":"Cardiothoracic Department Azienda Sanitaria Universitaria Integrata di Trieste and University of Trieste 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