Key result
Combined LGE and dyssynchrony on MRI predicts ~86% lower CRT response odds in nonischemic DCM.
Why the study?
To determine the association of cardiac MRI-measured myocardial fibrosis and left ventricular dyssynchrony with response to cardiac resynchronization therapy in nonischemic dilated cardiomyopathy.
Do cardiac MRI-derived myocardial fibrosis and ventricular dyssynchrony predict response to cardiac resynchronization therapy in patients with nonischemic dilated cardiomyopathy?
Observational (n=98)
Do cardiac MRI-derived myocardial fibrosis and ventricular dyssynchrony predict response to cardiac resynchronization therapy in patients with nonischemic dilated cardiomyopathy?
Effect estimate: OR 0.14 (95% CI 0.04-0.47)
p-value: p=0.002
Pre-therapy cardiac MRI assessment of myocardial fibrosis and circumferential dyssynchrony provides incremental prognostic value for predicting CRT response and long-term events in patients with nonischemic dilated cardiomyopathy.
May refine pre-CRT risk stratification in nonischemic DCM; hypothesis-generating and leaves open prospective validation.
Purpose To determine the association of myocardial fibrosis and left ventricular (LV) dyssynchrony measured using cardiac MRI with late gadolinium enhancement (LGE) and feature tracking (FT), respectively, with response to cardiac resynchronization therapy (CRT) for nonischemic dilated cardiomyopathy (DCM). Materials and Methods This retrospective study included 98 patients (mean age, 59 years ± 10 [SD]; 54 men) who had nonischemic DCM, as assessed with LGE cardiac MRI before CRT. Cardiac MRI FT–derived dyssynchrony was defined as the SD of the time-to-peak strain (TTP-SD) of the LV segments in three directions (longitudinal, radial, and circumferential). CRT response was defined as a 15% increase in LV ejection fraction (LVEF) at echocardiography at 6-month follow-up, and then, long-term cardiovascular events were assessed. The likelihood ratio test was used to evaluate the incremental prognostic value of LGE and dyssynchrony parameters. Results Seventy-one (72%) patients showed a favorable LVEF response following CRT. LGE presence (odds ratio: 0.14 [95% CI: 0.04, 0.47], P = .002; and hazard ratio: 3.52 [95% CI: 1.37, 9.07], P = .01) and lower circumferential TTP-SD (odds ratio: 1.04 [95% CI: 1.02, 1.07], P = .002; and hazard ratio: 0.98 [95% CI: 0.96, 1.00], P = .03) were independently associated with LVEF nonresponse and long-term outcomes. Combined LGE and circumferential TTP-SD provided the highest discrimination for LVEF nonresponse (area under the receiver operating characteristic curve [AUC]: 0.89 [95% CI: 0.81, 0.94], sensitivity: 84.5% [95% CI: 74.0%, 92.0%], specificity: 85.2% [95% CI: 66.3%, 95.8%]) and long-term outcomes (AUC: 0.84 [95% CI: 0.75, 0.91], sensitivity: 76.9% [95% CI: 56.4%, 91.0%], specificity: 87.0% [95% CI: 76.7%, 93.9%]). Conclusion Myocardial fibrosis and lower circumferential dyssynchrony assessed with pretherapy cardiac MRI were independently associated with unfavorable LVEF response and long-term events following CRT in patients with nonischemic DCM and may provide incremental value in predicting prognosis. Keywords: MR Imaging, Cardiac, Outcomes Analysis Supplemental material is available for this article.
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Song et al. (2023) conducted an observational in Nonischemic dilated cardiomyopathy (DCM) (n=98). Cardiac MRI with late gadolinium enhancement (LGE) and feature tracking (FT) was evaluated on CRT response (15% increase in LVEF at 6 months) and long-term cardiovascular events (OR 0.14, 95% CI 0.04-0.47, p=0.002). Combined LGE and circumferential dyssynchrony on pre-CRT cardiac MRI provided high discrimination for LVEF nonresponse (AUC 0.89; 95% CI 0.81-0.94) and long-term outcomes in nonischemic DCM.
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