Abstract 338: Contrast-Enhanced Cardiovascular Magnetic Resonance Predicts Cardiac Outcome Irrespective of Baseline Ejection Fraction in Nonischemic Cardiomyopathy
Background: Risk stratification in patients with nonischemic cardiomyopathy (NICM) remains challenging. Late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR) has emerged as a prognostic marker in patients with left ventricular systolic dysfunction. We evaluated the prognostic implications of LGE-CMR in nonischemic cardiomyopathy (NICM) in relation with baseline ejection fraction (EF).
Methods: We studied 219 NICM patients with left ventricular (LV) ejection fraction < 40% who underwent CMR and were followed prospectively during 849 days (397–1341) for an index composite event of cardiac death, heart failure hospitalization and ventricular arrhythmias.
Results: LGE-CMR were present in 73 patients (33%). According the findings of LGE-CMR and EF patients were divided into 6 groups:
EF<25% without LGE (n 55),
EF<25% with LGE (n 37),
EF between 25–35% without LGE (n 51),
EF between 25–35% with LGE (n 14),
EF>35% without LGE (n 40),
EF>35% with LGE (n 22).
During the follow-up 59 patients (27%) had a composite event. The event rate in patients with LGE was significantly higher than in patients without LGE regardless of baseline EF (41%, 36% and 42% in group 2 and 4, 6 vs 20%, 22% and 18% in groups 1,3 and 5; p<0.001). In multivariate analysis LGE-CMR was independent predictor of cardiac outcome (HR; CI 95% 1.03–3.14).
Conclusions: In patients with NICM, LGE-CMR identifies those with greater risk of cardiac events irrespective of its baseline EF. Thus, LGE- CMR significantly improves risk stratification in this high risk population and may become an useful tool for non-invasive risk stratification in this setting.