Abstract 18528: Junctional Late Enhancement in Non-ischemic Dilated Cardiomyopathy by Cardiac Magnetic Resonance: A Marker of Ventricular Adaptaton Due to Pulmonary Hypertension
Introduction: The potent prognostic impact of pulmonary hypertension (PH) in heart failure (HF) suggests an important role for pre-clinical detection of an ongoing RV remodeling. Several studies have highlighted the presence of late gadolinium enhancement (LGE) in the RV junction of the interventricular septum in the majority of these patients with pre-capillary PH.
Hypothesis: to evaluate in non-ischemic dilated cardiomyopathy (NIDC): 1) the prevalence of RV-LV junctional LGE, 2) the relationship between LGE and RV hemodynamics, and 3) its prognostic significance in terms of major events and HF outcome.
Methods: a consecutive series of NIDC patients. Exclusion criteria: recent onset of HF, contraindication to CMR. Diagnostic right heart catherization was performed in all. Follow up events: decompensated HF, cardiac death or heart transplantation and ventricular arrhythmias.
Results: 118 patients; 38 (32%) showed junctional LGE: in 9/38 LGE was confined only to the junctions points, in 19/38 associated with mid septal stria, in 10/38 with mid stria extended beyond the interventricular septum.In the junctional LGE group, the patients had increased RV EDV (97 vs 90 ml/m2, p=0.03), reduced RV EF (52 vs 57%; p<0.01), higher PH (61 vs 39%; p=0.027), LVEDP (84 vs 59%; p=0.006) and higher PCWP (61 vs 38%; p=0.019) with a mean value of 20 mmHg indicating a post-capillary pulmonary hypertension. During a median follow-up of 37 months Kaplan-Meier analysis revealed a significant correlation between junctional LGE and occurrence of HF (p=0.03). On univariate Cox regression analysis, all right catheterization parameters indicating a worse hemodynamics, including RV dysfunction/ dilation were associated with junctional LGE. On multivariable analysis, only the increased LVEDP showed a trend for prediction of HF (HR 2.8; 95% CI 0.886-9.453, P= 0.079).
Conclusions: Junctional LGE in the RV insertion points is a frequent CMR finding in NIDC, up to 32% in our population. A strict relationship with all hemodynamic parameters indicating PH is found, making this CMR pattern a marker of ventricular remodeling due to PH not only pre-capillary. Junctional LGE seems able to identify the patients at risk for developing HF.
Author Disclosures: M. Perazzolo Marra: None. M. De Lazzari: None. A. Frigo: None. B. Giorgi: None. G. De Conti: None. G. Tarantini: None. F. Tona: None. C. Basso: None. L. Cacciaillani: None. S. Iliceto: None.
- © 2014 by American Heart Association, Inc.