Abstract 19256: Prognostic Impact of Combination of Widened QRS Plus Gadlinium Enhancement on Mortality in DIlated Cardiomyopathy
Background: Late gadolinium enhancement (LGE) has been established as a prognostic indicator in non-ischemic cardiomyopathy. However, it is not necessarily ideal for detecting diffuse myocardial fibrosis in idiopathic dilated cardiomyopathy (DCM). Widened QRS (wQRS) on electrocardiogram (ECG) has been recognized as a simple index for predicting outcomes in patients with DCM. To avoid missing patients at high risk for cardiac events by assessing LGE-positive status alone, we wished to determine whether LGE plus wQRS is a better prognostic factor in patients with DCM.
Method: LGE and ECG results in consecutive 415 patients with DCM were examined. Any QRS morphology with QRS duration≥120ms were defined as wQRS. Patients were divided into four groups according to the presence or absence of LGE and wQRS: LGE-positive + wQRS-positive (n=83), LGE-positive + wQRS-negative (n=125), LGE-negative + wQRS-positive (n=50) and LGE-negative + wQRS-negative (n=157). The composite end point was cardiac death, cardiac transplantation, or LV assist device implantation.
Results: During median follow up of 57 months, 36 (8.7%) patients developed the composite end point. Kaplan-Meier curves analysis showed that the cardiac event free survival rate was lowest in the LGE-positive + wQRS-positive group and highest in the LGE-negative + wQRS-negative group (P<0.001) (Figure). Of note, there was no significant difference in the cardiac event-free survival rate between the LGE-positive + wQRS-negative and LGE-negative + wQRS-positive groups (P=NS) (Figure). Multivariable Cox regression analysis identified that the combination of the presence of LGE and wQRS was significantly associated with cardiac events (Hazard ratio 2.72, 95% CI 1.28 to 5.75, p<0.001)
Conclusion: The combination of LGE and wQRS provides more clinically relevant information for assessing the risk of cardiac events in patients with DCM than LGE status alone.
Author Disclosures: K. Marume: None. E. Tateishi: None. T. Kamakura: None. Y. Goto: None. Y. Morita: None. K.F. Kusano: None. S. Yasuda: None. T. Noguchi: None.
- © 2016 by American Heart Association, Inc.