Delayed Enhancement Magnetic Resonance Imaging Is a Significant Prognostic Factor in Patients With Non-Ischemic Cardiomyopathy

Abstract

Background: Delayed enhancement (DE) on cardiac magnetic resonance imaging (CMR) is a marker of myocardial fibrosis. The absence of DE in CMR is a predictor of left ventricular (LV) functional improvement in patients with non-ischemic cardiomyopathy (NICM), so in the present study it was investigated whether presence of DE has prognostic significance in patients with NICM at long-term follow-up. Methods and Results:The 79 patients (56.4±13.5 years, 48 males) with NICM (LV ejection fraction <35%, no significant coronary artery disease) were monitored for occurrence of cardiac events. CMR was performed to assess DE. Cardiac events were defined as rehospitalization (because of worsening of heart failure), cardiac transplantation or death. There were 37 patients without and 42 patients with DE. The mean follow-up duration was 19±10 months. There was 1 event (2.7%, 1 rehospitalization) in the DE (-) group, whereas 13 events (30.9%, 1 death, 1 transplantation, 11 rehospitalizations) occurred in the DE (+) group. The event-free survival was significantly longer in the DE (-) group than in the DE (+) group (38.9±1.0 vs 28.4±2.7 months, P<0.01). Multivariate regression analysis revealed that presence of DE was the most potent, independent predictor of cardiac events (hazard ratio 8.06, confidence interval 1.03±63.41, P<0.05). Conclusions:The presence of DE in CMR is a significant predictor of future cardiac events in patients with NICM. (Circ J 2010; 74: 476 - 483)

Clinical and Functional Correlates of Myocardial Fibrosis in Dilated Cardiomyopathy

“…Studies examining myocardial tissue samples obtained at the time of autopsy or cardiac transplantation have shown a pattern of increasing fibrosis from the epicardium to endocardium with both septal and LV free wall involvement [22][23][24]. The localization and incidence of irreversible injury is in agreement with previous CMR data [25,26], but higher than in a study by Assomull et al [9]. This may be due to different patient characteristics and the higher spatial resolution we applied.…”

Delayed enhancement on cardiac magnetic resonance imaging is a poor prognostic factor in patients with cardiac sarcoidosis

“…On the other hand, by using cardiac magnetic resonance imaging (CMRI) [28,29], we were able to demonstrate that DE-MRI was significantly associated with VA at baseline and showed a strong trend toward higher VA events on follow-up by Kaplan-Meier estimates. This finding also supports the role of CMRI as a risk stratification method for VA and adverse prognosis in various forms of structural heart disease, owing to its unique ability to accurately detect and delineate myocardial fibrosis, the presence and extent of which have become well-established markers of poorer prognosis [30][31][32][33][34][35]. Bello et al reported that scar burden was a significant predictor of VT inducibility, whereas LVEF was not [30].…”

Cardiac Microinjury Measured by Troponin T Predicts Collagen Metabolism in Adults Aged ≥65 Years With Heart Failure

“…These processes play an essential role in myocardial fibrosis and subsequent cardiac remodelling leading to HF (9–12). Recent studies also report the prognostic value of myocardial fibrosis identified by cardiac magnetic resonance imaging in both ischemic and non-ischemic cardiomyopathy (31;32). The present study showed that cTnT is cross-sectionally associated with elevated CITP and PIIINP levels, and in addition that increases in cTnT over a three-year period independently predict higher levels of these collagen metabolism markers at follow-up.…”