Abstract 13031: Novel Predictors of Left Ventricular Reverse Remodeling in Individuals with Recent Onset Dilated Cardiomyopathy

Abstract

Purpose: We aimed to compare performance of contrast-enhanced cardiac magnetic resonance imaging (CMRI), biomarkers and endomyocardial biopsy (EMB) results with conventional methods of follow-up to predict left ventricular reverse remodeling (LVRR) in individuals with recent- onset dilated cardiomyopathy (DCM).

Methods: 44 consecutive recent onset DCM patients [31 males (71%), age 43±11 years] with a median duration of symptoms 2.0 months (IQR 1.0-3.4) underwent CMRI, EMB, measurement of B-type natriuretic peptide (BNP), high-sensitivity cardiac troponin T and galectin-3, as well as a conventional cardiologic examination including cardiopulmonary exercise testing and echocardiography. Measurement of BNP and cardiologic examination were repeated at 3, 6 and 12 months, CMRI was repeated at 12 months. LVRR was defined as an increase in left ventricular ejection fraction ≥ 10 units to a final value of > 35% and a decrease in left ventricular end-diastolic dimension ≥ 10% at 12 months of follow-up.

Results: 20 individuals (45%) met the criteria of LVRR at 12 months of follow-up. At baseline, a decreasing quantity of late gadolinium enhancement [OR (95% CI) 0.67 (0.50; 0.90); p=0.008] and increasing T2 index [OR (95% CI) 1.45 (1.04; 2.02) ; p= 0.027] by contrast-enhanced CMRI were important predictors of LVRR independent of EMB results, biomarkers and the conventional methods. At three months, the recent BNP plasma level [OR (95% CI) 0.14 (0.02; 0.94) per log BNP; p= 0.047] was the only independent predictor of LVRR. Echocardiographic data, namely the indexed LVEDD and the E/Eratio, became the strongest predictor of LVRR as late as after 6 months of follow-up.

Conclusions: Both the CMRI findings and the serial BNP testing provide a better prediction of LVRR in recent-onset DCM than EMB results, other biomarkers and the conventional methods of cardiologic follow-up