Abstract 19798: Late Gadolinium Enhancement Pattern Predicts Prognosis in New Onset Heart Failure
Introduction: In patients with LV dysfunction, patterns of late gadolinium enhancement (LGE) on cardiac magnetic resonance imaging (CMRI) may be used to differentiate between dilated and ischemic cardiomyopathy. However, the prognostic significance of different LGE patterns in new onset heart failure (HF) is unknown.
Methods: We recruited consecutive patients, with no prior history of IHD, who presented with new onset HF between 2004–2006. All patients underwent coronary angiography and LGE-CMRI at 1.5T (Siemens Sonata, Erlangen, Germany). In each case, the pattern of LGE was categorised to no LGE, infarct pattern LGE or midwall LGE. Patients were prospectively followed up by regular telephone interview and outpatient clinic attendance. A comparison was made between the pattern of LGE and the primary endpoint of all-cause mortality and secondary composite end-point of mortality and HF hospitalization.
Results: The cohort comprised 120 patients (96 male, median age 57yrs). The mean LV ejection fraction (SD) was 39% (13%). LGE was present in 57 patients (47%) and absent in 63 (53%) patients. In patients with LGE, 32 (56%) had infarct pattern and 25 (44%) had midwall LGE. No patient had coexistent infarct pattern LGE and midwall LGE. Patients were followed up for a median of 49 months during which there were 18 deaths. Kaplan-Meier analysis revealed that LGE pattern was a significant predictor of the primary (p=0.03) (Fig.1) and secondary endpoints (p=0.009). On multivariate analysis, after adjustment for NYHA Class and LV ejection fraction, patients with infarct pattern LGE had a 2.7-fold higher risk of experiencing the primary outcome (p=0.039, CI 1.05 to 6.90).
Conclusions: In patients with new onset HF, the presence and pattern of LGE has independent prognostic value. In particular, infarct pattern LGE portends a worse prognosis. Our results demonstrate that LGE-CMRI may therefore assist with the management and risk-stratification of newly presenting HF patients.
- © 2010 by American Heart Association, Inc.