Abstract 9271: Late-Gadolinium Enhancement by Cardiac Magnetic Resonance Confers Additive Independent Prognostic Value in New-Presentation Idiopathic Dilated Cardiomyopathy
Introduction: Myocardial fibrosis and dyssynchronous ventricular contraction are hallmarks of idiopathic dilated cardiomyopathy (DCM). Previous studies have focussed on well established DCM, however the presence of myocardial fibrosis and ventricular dyssynchrony at first presentation and their effect on response to medical therapy is unknown. We hypothesised that myocardial fibrosis by late gadolinium enhancement cardiac magnetic resonance (LGE-CMR) and ventricular dyssynchrony by echocardiography, are independent predictors of change in left ventricular ejection fraction (LVEF) following therapy in patients with newly diagnosed DCM.
Methods: In a prospective study of 68 patients within 2 weeks of a new diagnosis of DCM, patients underwent LGE-CMR, echocardiography, 6-minute walk test, cardiopulmonary exercise testing, and measurement of NT-pro BNP concentration a median 12.5 days (IQR 7–23 days) and 5 months (IQR 4–7 months) following index presentation. The predictive value of baseline covariates for change in LVEF was evaluated by mixed effects modelling.
Results: On multivariate analysis, late gadolinium enhancement by CMR and QRS duration were independent predictors of failure of improvement in LVEF at follow-up (Table). LGE-CMR added incremental prognostic value in a multivariate model for prediction of follow-up LVEF (p<0.001). Interventricular and intra-LV dyssynchrony at baseline were not associated with magnitude of change in LVEF at follow-up. The presence of LGE at baseline was associated with adverse outcomes with respect to global LV strain, left atrial remodelling and function, and interventricular and intra-LV dyssynchrony.
Conclusions: This study strongly suggests a role for LGE CMR as a risk stratifying investigation in cases of newly diagnosed DCM. Identification of individuals at high risk of non-response at first clinical presentation may permit more aggressive and targeted heart failure therapy.
- © 2010 by American Heart Association, Inc.