What does this research mean for the field?

While late gadolinium enhancement (LGE) on cardiac MRI is associated with worse unadjusted outcomes in newly diagnosed non-ischemic cardiomyopathy, it is not an independent prognostic predictor when accounting for traditional risk factors like left ventricular ejection fraction and troponin I. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

February 20, 2013Open Access

Prognostic Value of Contrast-enhanced Cardiac Magnetic Resonance Imaging in Patients with Newly Diagnosed Non-Ischemic Cardiomyopathy: Cohort Study

Structured PICO

Does the presence of late gadolinium enhancement on cardiac magnetic resonance imaging predict adverse clinical outcomes in patients with newly diagnosed non-ischemic cardiomyopathy?

Population

185 consecutive patients presenting with newly diagnosed (<4 weeks) non-ischemic cardiomyopathy (coronary artery disease excluded by coronary angiography), mean age 51.2 years, 28.6% female. Suspected etiologies included dilated cardiomyopathy (55.1%), myocarditis (35.1%), hypertrophic/hypertensive cardiomyopathy (8.1%), and storage disease (1.6%).

Intervention

Late gadolinium enhancement (LGE) assessment via contrast-enhanced cardiac magnetic resonance (CMR) imaging using 0.15 mmol/kg intravenous gadobutrol

Comparator

Absence of late gadolinium enhancement (LGE-negative) on cardiac magnetic resonance imaging

Outcome

Composite of all-cause mortality, heart transplantation, aborted sudden death, sustained ventricular tachycardia, or hospitalization due to decompensated heart failure within three years of follow-upcomposite

In patients with newly diagnosed non-ischemic cardiomyopathy, LGE on CMR is associated with worse prognosis univariably, but traditional markers like LVEF ≤40% and elevated troponin I are stronger, independent predictors of adverse outcomes.

Abstract

BACKGROUND: Owing to its variable course from asymptomatic cases to sudden death risk stratification is of paramount importance in newly diagnosed non-ischemic cardiomyopathy. We tested whether late gadolinium enhancement (LGE) assessed by cardiac magnetic resonance (CMR) imaging is a prognostic marker in consecutive patients with newly diagnosed non-ischemic cardiomyopathy. METHODS: We enrolled 185 patients who presented for evaluation of newly diagnosed non-ischemic cardiomyopathy. Coronary artery disease was excluded by coronary angiography. Following risk markers were additionally assessed: NYHA functional class (≥II), brain natriuretic peptide (>100 ng/l), troponin I (TnI, ≥0.03 µg/l), left ventricular ejection fraction (LVEF, ≤40%), left ventricular enddiastolic diameter (>55 mm) and QRS duration (>98 ms). Endpoint of the study was the composite of all-cause mortality, heart transplantation, aborted sudden death, sustained ventricular tachycardia or hospitalization due to decompensated heart failure within three years of follow-up. RESULTS: During median follow-up of 21 months, 54 patients (29.2%) reached the composite endpoint. Ninety-four of the 185 patients (50.8%) were judged LGE-positive. Prognosis of LGE-positive patients was significantly worse than that of LGE-negative patients (cumulative 3-year event rates of 67.4% in LGE-positive and 27.2% in LGE-negative patients, respectively; p = 0.021). However, in multivariable analysis, presence of LGE was not an independent predictor of outcome. Only LVEF ≤40% and TnI ≥0.03 µg/l were independent risk predictors of the composite endpoint yielding relative risks of 3.9 (95% CI 1.9-8.1; p<0.0001) and 2.2 (95% CI 1.2-4.0; p = 0.014), respectively. CONCLUSIONS: In consecutive patients presenting with newly diagnosed non-ischemic cardiomyopathy, LGE-positive patients had worse prognosis. However, only traditional risk parameters like left ventricular performance and cardiac biomarkers but not presence of LGE were independent risk predictors.

Bookmark

View Full Paper