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- Title
Prognostic value of myocardial strain and late gadolinium enhancement on cardiovascular magnetic resonance imaging in patients with idiopathic dilated cardiomyopathy with moderate to severely reduced ejection fraction.
- Authors
Pi, Seung-Hoon; Kim, Sung Mok; Choi, Jin-Oh; Kim, Eun Kyoung; Chang, Sung-A; Choe, Yeon Hyeon; Lee, Sang-Chol; Jeon, Eun-Seok
- Abstract
Background: It has been reported that left ventricular (LV) myocardial strain and late gadolinium enhancement (LGE) on cardiovascular magnetic resonance (CMR) imaging have prognostic value in patients with heart failure (HF). However, previous studies included patients with various systolic functions. This study aimed to investigate the prognostic value of LV myocardial strain and LGE on CMR imaging in patients with idiopathic dilated cardiomyopathy (DCM) with reduced ejection fraction (EF < 40%). Methods: From a prospectively followed cohort who underwent CMR between November 2008 and December 2015, subjects with LV EF < 40% and a diagnosis of idiopathic DCM were eligible for this study. The CMR images were analyzed for LV and right ventricular (RV) function, presence and extent of LGE, and LV myocardial strain. The primary outcome was a composite of all-cause death and heart transplantation. The secondary outcome was hospitalization for HF. Results: A total of 172 patients were included, in whom mean LV EF was 23.7 ± 7.9% (EF 30–40% <italic>n</italic> = 47; EF < 30% <italic>n</italic> = 125). During a median follow-up of 47 months, the primary outcome occurred in 43 patients (16 heart transplantations, 29 all-cause deaths), and there were 41 hospitalizations for HF. Univariate Cox proportional hazard regression analysis showed that mean arterial pressure, serum sodium concentration, log of plasma NT-proBNP level, and presence of LGE (HR 2.277, 95% CI: 1.221–4.246) were significantly associated with the primary outcome. However, LV strain had no significant association (HR 1.048, 95% CI: 0.945–1.163). Multivariable analysis showed that presence of LGE (HR 4.73, 95% CI: 1.11–20.12) and serum sodium (HR 0.823, 95% CI: 0.762–0.887) were independently associated with the primary outcome. Conclusions: LGE in CMR imaging was a good predictor of adverse outcomes for patients with idiopathic DCM and reduced EF. Identification of LGE could thus improve risk stratification in high-risk patients. LV strain had no significant prognostic value in patients with moderate to severe systolic dysfunction.
- Subjects
ARTERIES; DILATED cardiomyopathy; BLOOD pressure; CARDIOVASCULAR disease diagnosis; CONFIDENCE intervals; CAUSES of death; LEFT heart ventricle; HEART physiology; RIGHT heart ventricle; HEART transplantation; HEART failure; HOSPITAL care; LONGITUDINAL method; MAGNETIC resonance imaging; MULTIVARIATE analysis; PEPTIDE hormones; REGRESSION analysis; RISK assessment; SODIUM; STATISTICS; CONTRAST media; PROPORTIONAL hazards models; ADVERSE health care events; ODDS ratio; VENTRICULAR ejection fraction; PROGNOSIS; DIAGNOSIS; PHYSIOLOGY
- Publication
Journal of Cardiovascular Magnetic Resonance (BioMed Central), 2018, Vol 20, Issue 1, pN.PAG
- ISSN
1532-429X
- Publication type
Article
- DOI
10.1186/s12968-018-0466-7