When and how does dilated cardiomyopathy recover in children?

Background: Much has been learned since the 1980s regarding the epidemiology, etiology, and outcomes of children with dilated cardiomyopathy (DCM). However, relatively little is understood about myocardial recovery in pediatric DCM: (1) when does pediatric DCM recover; (2) what are the predictors of recovery; (3) what are the clinical features of recovery; and (4) what are clinical and research gaps? Aim of Review: A purpose of the Fifth International Conference on Childhood Cardiomyopathy was to update researchers and clinicians with interests in pediatric cardiomyopathy and heart failure on recent findings in myocardial recovery in DCM. This review is a summary of literature with details on cardiac recovery, not simply survival, in children with DCM. Key Scientific Concepts of Review: More children with DCM are surviving without heart transplant in the current era of heart failure management, but the rate of recovery in these survivors is not widely known. Recovery of cardiac function ranges from 11-52% across multiple single and multi- center studies. Robust predictors for myocardial recovery in pediatric DCM are lacking. Future studies need to identify non-invasive markers of recovery to guide both prognostication at the time of diagnosis and to evaluate pharmaceuticals or device therapies that promote recovery. Studies of myocardial recovery in children need to include quality of life measures, long-term outcomes, and risk factors for heart failure recurrence or sudden death.