Key result
In asymptomatic patients with suspected dilated cardiomyopathy, a low peak exercise cardiac index (<35th percentile) was significantly associated with adverse cardiovascular events compared to those with higher exercise capacity (7 events vs 0 events, P=0.004).
Why the study?
Imaging features of dilated cardiomyopathy overlap with physiological exercise-induced cardiac remodeling, making differentiation challenging.
Does exercise stress CMR predict adverse cardiovascular events and distinguish pathological DCM from physiological remodeling in asymptomatic patients with suspected DCM?
Cohort (n=160)
No
Does exercise stress CMR predict adverse cardiovascular events and distinguish pathological DCM from physiological remodeling in asymptomatic patients with suspected DCM?
p-value: p=0.004
Exercise stress CMR can help distinguish pathological DCM from physiological exercise-induced cardiac remodeling, with low peak exercise cardiac index predicting adverse cardiovascular events.
May refine risk stratification in asymptomatic suspected dilated cardiomyopathy; leaves open need for prospective validation before clinical use.
Objectives The imaging features of dilated cardiomyopathy (DCM) overlap with physiological exercise-induced cardiac remodeling in active and otherwise healthy individuals. Distinguishing the two conditions is challenging. This study examined the diagnostic and prognostic roles of exercise stress imaging in asymptomatic patients with suspected DCM. Methods Exercise stress cardiovascular magnetic resonance (CMR) was performed in 60 asymptomatic patients with suspected DCM (dilated left ventricle and/or impaired systolic function on CMR), who also underwent DNA sequencing for DCM-causing genetic variants. Confirmed DCM was defined as genotype- and phenotype-positive (G+P+). Another 100 healthy subjects were recruited to establish normal exercise capacities (peak exercise cardiac index; Peak CI ). The primary outcome was a composite of all-cause mortality, cardiac decompensation and ventricular arrhythmic events. Results No patients with confirmed G+P+ DCM had Peak CI exceeding the 35th percentile specific for age and sex. Applying this threshold in G-P+ patients, those with Peak CI below 35th percentile had characteristics similar to confirmed DCM while patients with higher Peak CI were younger, more active and higher longitudinal strain. Adverse cardiovascular events occurred only in patients with low exercise capacity ( P = 0.004). Conclusions In individuals with suspected DCM, exercise stress CMR demonstrates diagnostic and prognostic potential in distinguishing between pathological DCM and physiological exercise-induced cardiac remodeling .
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Le et al. (2020) conducted a cohort in Suspected dilated cardiomyopathy (n=160). Low peak exercise cardiac index (<35th percentile) vs. High peak exercise cardiac index (≥35th percentile) was evaluated on Composite of all-cause mortality, cardiac decompensation and ventricular arrhythmias (p=0.004). In asymptomatic patients with suspected dilated cardiomyopathy, a low peak exercise cardiac index (<35th percentile) was significantly associated with adverse cardiovascular events compared to those with higher exercise capacity (7 events vs 0 events, P=0.004).
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