Abstract 400: Cardiac Magnetic Resonance Provides Strong Prognostic Value for Cardiac Death in Patients With Left Ventricular Dysfunction and No Evidence of Coronary Artery Disease
Background: Noninvasive assessment of patients who present with left ventricular systolic dysfunction (LVD) without a history of coronary artery disease (CAD) has therapeutic and prognostic implications. We hypothesize that cardiac magnetic resonance (CMR) imaging, with its high sensitivity to detect myocardial tissue characteristics, can provide strong prognostic value in patients who present with cardiomyopathy whose etiology has not been diagnosed.
Methods: We studied 258 consecutive patients with LVD (defined by LVEF <50%) without prior evidence of CAD who were referred for CMR assessment. Cine ventricular function and late gadolinium enhancement (LGE) imaging were obtained. Patients were then followed for cardiac death (DEATHCV) over a median of 2 years.
Results: Successful follow-up was obtained in 100% of patients (mean age 53±15 years, 62% male). Average LVEF and RVEF were 37±10% and 46±12%, respectively. DEATHCV occurred in 21 (8%) patients over the study period. Patient age, diabetic history, presence of ECG Q wave, and presence of LGE were the strongest univariable predictors for DEATHCV (for LGE, HR = 4.98; p= 0.0002, Figure⇓). Adjusting for age, diabetes, and Q wave, LGE presence portended a robust association with DEATHCV, maintaining a >4-fold adjusted elevated hazards (P= 0.004). In addition, adjusted for LVEF, RVEF, and LV mass, LGE demonstrated strong incremental association with DEATHCV (adjusted HR 3.79, p= 0.01).
Conclusion: In a patient cohort of LVD of undiagnosed etiology, LGE imaging provided incremental prognostic value for DEATHCV beyond the strongest clinical variables, and beyond ventricular functions and myocardial mass.