Abstract 18189: Focal Fibrosis and Diffuse Fibrosis Are Predictors of Positive Left Ventricular Remodeling in Patients With Non-Ischemic Cardiomyopathy
Prognostic value of myocardial fibrosis in patients with non-ischemic idiopathic cardiomyopathy (NICM) is not well-defined. We sought to assess the association of focal and diffuse myocardial fibrosis to left ventricular reversed remodeling.
Patients with NICM who underwent cardiac MRI and baseline and subsequent follow-up echocardiographic were included in the study. Post-contrast T1 times were measured using Look-Locker gradient echo, and was adjusted for renal function, body size, gadolinium dose and delayed time after Gadolinium injection. Patients were followed over a median time of 29 months (20,37) to evaluate changes of left ventricular end-systolic volume index (LVESVi) over time. Linear Mixed Model was used to assess the relationship between the LVESVi during follow-up,T1 value, and delayed hyperenhancement (DHE).
Results: A total of 103 patients (mean age 51±15 years, 62% male) were included in the analysis. Mean LVEF 32±10%, LVESVi 62±39 ml/m2, and T1 time 415+98. DHE was identified in 45 patients (44%). Age, LVEF and LVESVi in patients with DHE are not statistically different compared to patients without DHE. Patient with DHE were more likely to be male (32 vs 11, p=0.024) and had lower T1 time (381±104 Vs 440±87, p=0.003). Patients with focal DHE (n=45) had higher LVESVi at baseline and during follow-up, compared to the patients with no DHE (Δ= 11.3 ml/m2 SE 8.8 ml/2, p= 0.024) (Figure A). However, post T1 values of the myocardium without DHE were not associated with differences in LVESVi. In patients without DHE (n=58), T1 value > 450 was associated with further reduction in LVESVi at the follow-up (Δ= 24.6 ml/m2 SE 14.6 ml/2, p= 0.048)(Figure B.)
Conclusion: Presence of myocardial DHE, but not T1 value, is a marker of LV reversed remodeling in NICM patients. However, diffuse fibrosis predicts LV reversed remodling in patients without DHE.
- © 2013 by American Heart Association, Inc.