Key result
The combined presence of late gadolinium enhancement and angio-IMR > 45 U increased the risk of all-cause mortality or heart failure hospitalization (HR 12.20) in dilated cardiomyopathy patients.
Why the study?
Coronary microvascular dysfunction has recently been linked to adverse events in heart failure, but its relationship with late gadolinium enhancement and prognostic value in dilated cardiomyopathy remained to be investigated.
Observational (n=108)
No
Effect estimate: HR 12.20 (95% CI 2.40-62.10)
Absolute Event Rate: 41.2% vs 4.3%
p-value: p=0.001
The combination of late gadolinium enhancement and high angiography-derived index of microcirculatory resistance is a strong independent predictor of mortality and heart failure hospitalization in patients with dilated cardiomyopathy.
May aid risk stratification in dilated cardiomyopathy; hypothesis-generating and should not yet change practice.
Background: Coronary microvascular dysfunction (CMD) has recently been associated with adverse cardiovascular events in patients with heart failure. We investigated the relationship between late gadolinium enhancement (LGE) and CMD, as well as the prognostic value of CMD in predicting long-term prognosis in patients with dilated cardiomyopathy (DCM). Methods: Patients with DCM who underwent both cardiac magnetic resonance imaging and coronary angiography were consecutively enrolled. CMD was evaluated using the angiography-derived index of microcirculatory resistance (angio-IMR). The primary endpoint was composite endpoints of all-cause mortality or heart failure hospitalization within 3 years. Results: Among 108 patients (median age, 64 years; women, 27 %), 18 % (19 patients) experienced composite endpoints. The median angio-IMR was 45 U, and LGE was identified in 23 %. Angio-IMR was significantly higher in patients with LGE than in those without LGE. When patients were stratified based on the combined presence of LGE and angio-IMR, significant differences in composite endpoints were observed among the three groups (LGE absence and low angio-IMR: 4.3 % vs. LGE presence or high angio-IMR: 22.2 % vs. LGE presence and high angio-IMR: 41.2 %, log-rank test p < 0.01). In multivariable Cox proportional hazards model for composite endpoints, LGE presence and angio-IMR >45 U was an independent predictor: hazards ratio 12.20, 95 % confidence interval 2.40-62.10, p = 0.001. Conclusion: CMD evaluated using angio-IMR was associated with LGE and long-term prognosis in patients with DCM. Further investigations are needed to elucidate the relationship among CMD, LGE, and prognosis.
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Kawamura et al. (2025) conducted an observational in Dilated cardiomyopathy (n=108). Combined presence of late gadolinium enhancement (LGE) and angio-IMR > 45 U vs. LGE absence and low angio-IMR was evaluated on Composite of all-cause mortality or heart failure hospitalization within 3 years (HR 12.20, 95% CI 2.40-62.10, p=0.001). The combined presence of late gadolinium enhancement and angio-IMR > 45 U increased the risk of all-cause mortality or heart failure hospitalization (HR 12.20) in dilated cardiomyopathy patients.
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