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Prognostic value of late gadolinium enhancement in cardiac MRI of non-ischemic dilated cardiomyopathy patients.

ABSTRACT: BACKGROUND:The role of late gadolinium enhancement (LGE) in cardiac MRI (CMR) as prognostic marker in non-ischemic dilated cardiomyopathy (NIDCM) is evolving. OBJECTIVE:To study the effect of LGE in the prognosis of NIDCM patients. METHODS:112 consecutive NIDCM patients, who underwent CMR, were prospectively followed up for 745 ± 320 days. Primary end point was occurrence of MACE {composite of all-cause mortality, resuscitated cardiac arrest, sustained ventricular tachycardia (VT)/appropriate ICD shock, heart failure (HF) hospitalization}. RESULTS:LGE was present in 44 out of 112 patients (39%). The primary end point (MACE) was significantly higher in LGE + ve group compared to the LGE -ve group (72.7% vs. 29.4%; p < 0.0001). Similarly, cardiac mortality (9.1% vs 2.9%; p < 0.049), VT (13.6% vs. 2.9%; p < 0.031), HF hospitalization (63.6% vs. 30.9%; p < 0.001) were significantly more in LGE + ve group. In univariate model, LGE demonstrated the strongest association with MACE (Hazard ratio [HR] = 2.96 [95% CI 1.685 to 5.201; p < 0.0001). LGE extent of >14% of LV predicted MACE with 90.6% sensitivity and 86% specificity. HR of LGE extent >14% of LV for MACE is 6.12; p < 0.01. LGE was associated with MACE irrespective of its location, pattern or distribution. Multivariate model showed LGE and its extent >14% of LV volume were strongest predictor of MACE. CONCLUSION:LGE and its extent >14% predicts adverse cardiac events in NIDCM irrespective of LVEF and LGE location, pattern or distribution. This study emphasises the role of CMR in risk stratification of NIDCM patients and guiding therapy.

SUBMITTER: Behera DR

PROVIDER: S-EPMC7670245 | biostudies-literature | 2020 Sep - Oct

REPOSITORIES: biostudies-literature

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Prognostic value of late gadolinium enhancement in cardiac MRI of non-ischemic dilated cardiomyopathy patients.

Behera Dibya Ranjan DR V K Ajit Kumar AK K K Narayanan Namboodiri NN S Sivasankaran S Nair Krishna Kumar Mohanan KKM G Sanjay S T R Kapilamoorthy K Gopalakrishnan Arun A S Harikrishnan H

Indian heart journal 20200702 5

<h4>Background</h4>The role of late gadolinium enhancement (LGE) in cardiac MRI (CMR) as prognostic marker in non-ischemic dilated cardiomyopathy (NIDCM) is evolving.<h4>Objective</h4>To study the effect of LGE in the prognosis of NIDCM patients.<h4>Methods</h4>112 consecutive NIDCM patients, who underwent CMR, were prospectively followed up for 745 ± 320 days. Primary end point was occurrence of MACE {composite of all-cause mortality, resuscitated cardiac arrest, sustained ventricular tachycard ...[more]

PMID: 33189195

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Project description:BackgroundLate gadolinium enhancement (LGE) cardiac magnetic resonance (CMR) imaging has emerged as an important tool for assessment of patients with dilated cardiomyopathy (DCM). Electrocardiography (ECG) is an accessible, reproducible, low-cost diagnostic and prognostic tool. This study aimed to investigate the ECG characteristics associated with LGE, as well as to assess the prognostic significance of ECG in patients with DCM.MethodsConsecutive patients diagnosed with DCM by CMR [left ventricular ejection fraction (LVEF) < 50%] between 2011 and 2020 were included. Multivariable analysis was conducted to evaluate ECG predictors associated with LGE. Receiver operating characteristic (ROC) analysis was performed to assess the diagnostic performance of ECG in combination of clinical data and LVEF for LGE. Two composite outcomes were also assessed among patients with and without ECG predictors: (1) sudden cardiac death (SCD), sustained ventricular arrhythmia, or appropriate implantable cardioverter-defibrillator (ICD) therapy, and (2) all-cause death or hospitalization for heart failure.ResultsA total of 422 patients, with a mean age of 59.5 ± 16.3 years (58.3% male), were included. LGE was present in 169 (40%) of the patients. Multivariable analysis identified lateral inverted T-waves, intraventricular conduction delay, low voltage, and fragmented QRS as independent predictors of LGE. ROC analysis showed a significant increase in the area under the curve (AUC) when ECG predictors of the four aforementioned characteristics were added to the clinical-LVEF model (AUC 0.66, 95% CI 0.59-0.71 vs. 0.72, 95% CI 0.67-0.78, p = 0.003). During a median follow-up of 2.7 years (IQR 0.8, 5.2), 16 events of SCD, sustained ventricular arrhythmia, or appropriate ICD therapy, and 70 events of all-cause death or hospitalization for heart failure occurred. ECG predictors were independently associated with SCD, sustained ventricular arrhythmia, or appropriate ICD therapy (HR 4.84, 95% CI 1.34-17.40, p = 0.01). However, ECG predictors were not associated with all-cause death or hospitalization for heart failure (HR 1.22, 95% CI 0.76-1.96, p = 0.39).ConclusionIn patients with DCM, lateral inverted T-waves, intraventricular conduction delay, low voltage, and fragmented QRS were independently associated with LGE. Additionally, these ECG predictors had prognostic value for predicting SCD, sustained ventricular arrhythmia, or appropriate ICD therapy, assisting clinicians in stratifying SCD risk and identifying primary prevention ICD implantation candidates.

Project description:AimsThis study aimed to evaluate the clinical parameters including late gadolinium enhancement (LGE) of cardiovascular magnetic resonance to predict re-worsening of left ventricular ejection fraction (LVEF) in patients with dilated cardiomyopathy (DCM).Methods and resultsWe included 138 patients with recent-onset DCM who had an LVEF <45% and underwent LGE of cardiovascular magnetic resonance imaging at diagnosis and echocardiography at the yearly follow-up [median 6 (4-8.3) years]. Initial LVEF recovery was defined as LVEF increase >10% from baseline, resulting in LVEF ≧45% after treatment. The patients were divided into three groups: (i) improved (n = 83, 60%), defined as those with sustained LVEF ≧45%; (ii) re-worsening (n = 39, 28%), those with >5% decrease and LVEF <45% after the initial LVEF recovery; and (iii) not-improved (n = 16, 12%), those without initial LVEF recovery. The primary endpoint was a composite of hospitalization for heart failure or sudden cardiac death. In baseline, LGE was observed in 70 patients. The LGE area was significantly larger in the re-worsening and not-improved groups than that in the improved group (P < 0.001). Loess curves of long-term LVEF trajectories showed that LVEF in the re-worsening group increased in the first 2 years and slowly declined thereafter. Multivariate logistic regression analysis demonstrated that LGE area [odds ratio (OR) 1.09, 95% confidence interval (CI) 1.03-1.16, P = 0.004], B-type natriuretic peptide (OR 1.49, 95% CI 1.05-2.21, P = 0.030) level at the initial recovery, and LVEF (OR 0.91, 95% CI 0.86-0.97, P = 0.004) at the initial LVEF recovery were independent predictors of re-worsening of LVEF. During a median follow-up of 2273 (interquartile range: 1634-3191) days, the primary endpoint was observed in 31 (22%) patients. Univariate Cox proportional hazards analysis demonstrated that the risk of experiencing the primary event in the re-worsening group was significantly higher (hazard ratio: 4.30, 95% CI 1.63-11.31, P = 0.003) than that in the improved group and was lower than that in the not-improved group (hazard ratio: 0.33, 95% CI 0.15-0.72, P = 0.006).ConclusionsRe-worsening of LVEF was observed in 28% of patients with recent-onset DCM who showed an initial improvement in LVEF. High LGE burden, higher B-type natriuretic peptide level, and lower LVEF at the initial LVEF recovery were independent predictors of re-worsening of LVEF in patients with DCM. Careful observation is recommended for patients with a high risk for re-worsening of LVEF, even in those with an initial LVEF recovery.

Project description:BACKGROUND:It has been reported that left ventricular (LV) myocardial strain and late gadolinium enhancement (LGE) on cardiovascular magnetic resonance (CMR) imaging have prognostic value in patients with heart failure (HF). However, previous studies included patients with various systolic functions. This study aimed to investigate the prognostic value of LV myocardial strain and LGE on CMR imaging in patients with idiopathic dilated cardiomyopathy (DCM) with reduced ejection fraction (EF?<?40%). METHODS:From a prospectively followed cohort who underwent CMR between November 2008 and December 2015, subjects with LV EF?<?40% and a diagnosis of idiopathic DCM were eligible for this study. The CMR images were analyzed for LV and right ventricular (RV) function, presence and extent of LGE, and LV myocardial strain. The primary outcome was a composite of all-cause death and heart transplantation. The secondary outcome was hospitalization for HF. RESULTS:A total of 172 patients were included, in whom mean LV EF was 23.7?±?7.9% (EF 30-40% n?=?47; EF?<?30% n?=?125). During a median follow-up of 47 months, the primary outcome occurred in 43 patients (16 heart transplantations, 29 all-cause deaths), and there were 41 hospitalizations for HF. Univariate Cox proportional hazard regression analysis showed that mean arterial pressure, serum sodium concentration, log of plasma NT-proBNP level, and presence of LGE (HR 2.277, 95% CI: 1.221-4.246) were significantly associated with the primary outcome. However, LV strain had no significant association (HR 1.048, 95% CI: 0.945-1.163). Multivariable analysis showed that presence of LGE (HR 4.73, 95% CI: 1.11-20.12) and serum sodium (HR 0.823, 95% CI: 0.762-0.887) were independently associated with the primary outcome. CONCLUSIONS:LGE in CMR imaging was a good predictor of adverse outcomes for patients with idiopathic DCM and reduced EF. Identification of LGE could thus improve risk stratification in high-risk patients. LV strain had no significant prognostic value in patients with moderate to severe systolic dysfunction.

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Prognostic value of late gadolinium enhancement in cardiac MRI of non-ischemic dilated cardiomyopathy patients.

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Prognostic value of late gadolinium enhancement in cardiac MRI of non-ischemic dilated cardiomyopathy patients.

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