Published online before print October 13, 2003, doi: 10.1161/01.CIR.0000095029.57483.60
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(Circulation. 2003;108:1945.)
© 2003 American Heart Association, Inc.
Clinical Investigation and Reports |
Gadolinium Cardiovascular Magnetic Resonance Predicts Reversible Myocardial Dysfunction and Remodeling in Patients With Heart Failure Undergoing ß-Blocker Therapy
From the Feinberg Cardiovascular Research Institute, Division of Cardiology, Northwestern University, Chicago, Ill (D.B., G.M.F., S.D.L., M.R.J., W.G.C., F.J.K., R.O.B., M.G.); and Duke Cardiovascular Magnetic Resonance Center, Division of Cardiology, Duke University, Durham, NC (D.J.S., M.P., R.M.J., R.J.K.).
Correspondence to Raymond J. Kim, MD, Duke Cardiovascular MRI Center, DUMC-3934, Durham, NC 27710. E-mail raymond.kim{at}dcmrc.mc.duke.edu
Received January 9, 2003; de novo received May 16, 2003; revision received July 21, 2003; accepted July 21, 2003.
Background— In some patients with heart failure, ß-blockers can improve left ventricular (LV) function and reduce morbidity and mortality. We hypothesized that gadolinium-enhanced cardiovascular magnetic resonance imaging (CMR) can predict reversible myocardial dysfunction and remodeling in heart failure patients treated with ß-blockers.
Methods and Results— Forty-five patients with chronic heart failure underwent CMR. Contrast imaging using gadolinium was performed to obtain high-resolution spatial maps of myocardial scarring and viability. Cine imaging was performed to assess LV function and morphology and was repeated in 35 patients after 6 months of ß-blockade. Gadolinium CMR demonstrated scarring in 30 of 45 patients (67%). Scarring was found in 100% of patients with ischemic cardiomyopathy (28 of 28) but in only 12% with nonischemic cardiomyopathy (2 of 17). In the 35 patients who were maintained on ß-blockers and had a second study, there was an inverse relation between the extent of scarring at baseline and the likelihood of contractile improvement 6 months later (P<0.001). For instance, contractility improved in 56% (674 of 1207) of regions with no scarring but in only 3% with >75% scarring (8 of 232). Multivariate analysis showed that the amount of dysfunctional but viable myocardium by CMR was an independent predictor of the change in ejection fraction (P=0.01), mean wall motion score (P=0.0007), LV end-diastolic volume index (P=0.007), and LV end-systolic volume index (P
0.0001).
Conclusions— For heart failure patients treated with ß-blockers, gadolinium-enhanced CMR predicts the response in LV function and remodeling.
Key Words: heart failure • receptors, adrenergic, beta • cardiomyopathy • magnetic resonance imaging
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