Key result
The amount of late gadolinium enhancement on cardiac magnetic resonance was an independent risk factor for adverse cardiovascular events in patients with stage C or D heart failure (HR 1.045 per 1% increase).
Why the study?
Does the amount of late gadolinium enhancement on cardiac magnetic resonance predict adverse cardiovascular events in patients with stage C or D heart failure?
Cohort (n=84)
Single-blind (outcome assessors)
No
Does the amount of late gadolinium enhancement on cardiac magnetic resonance predict adverse cardiovascular events in patients with stage C or D heart failure?
The amount of late gadolinium enhancement on CMR is an independent predictor of adverse cardiovascular events in patients with advanced (stage C or D) heart failure, offering prognostic value beyond LVEF.
Answers are grounded in this paper and cite their sources.
May aid prognostication beyond LVEF in stage C/D HF; hypothesis-generating for CMR integration pending prospective validation.
Background Myocardial fibrosis (MF) is a risk factor for poor prognosis in dilated cardiomyopathy (DCM). Late gadolinium enhancement (LGE) of the myocardium on cardiac magnetic resonance (CMR) represents MF. We examined whether the LGE amount increases the incidence of adverse cardiovascular events in patients with stage C or D heart failure (HF). Methods Eighty-four consecutive patients with stage C or D HF, either ischemic or non-ischemic, were enrolled. Comprehensive clinical and CMR evaluations were performed. All patients were followed up for a composite endpoint of cardiovascular death, heart transplantation, and cardiac resynchronization therapy with defibrillator (CRT-D). Results LGE was present in 79.7% of the end-stage HF patients. LGE distribution patterns were mid-wall, epi-myocardial, endo-myocardial, and the morphological patterns were patchy, transmural, and diffuse. During the average follow-up of 544 days, 13 (15.5%) patients had endpoint events: 7 patients cardiac death, 2 patients heart transplantation, and 4 patients underwent CRT-D implantation. On univariate analysis, LGE quantification on cardiac magnetic resonance, blood urine nitrogen, QRS duration on electrocardiogram, left ventricular end-diastolic diameter (LVEDD) and left ventricular end-diastolic volume (LVEDV) on CMR had the strongest associations with the composite endpoint events. However, on multivariate analysis for both Model I (after adjusting for age, sex, and body mass index) and Model II (after adjusting for age, sex, BMI, renal function, QRS duration and atrial fibrillation on electrocardiogram, the etiology of HF, LVEF, CMR-LVEDD and CMR-LVEDV), LGE amount was a significant risk factor for composite endpoint events (Model I 6SD HR 1.037, 95%CI 1.005-1.071, p=0.022; Model II 6SD HR 1.045, 95%CI 1.001-1.084, p=0.022). Conclusion LGE amount from high-scale threshold on CMR increased the incidence of adverse cardiovascular events for patients in either stage C or D HF.
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Liu et al. (2016) conducted a cohort in Stage C or D heart failure (n=84). Late gadolinium enhancement (LGE) amount vs. Lower LGE amount was evaluated on Composite of cardiovascular death, heart transplantation, and cardiac resynchronization therapy with defibrillator (CRT-D) (HR 1.045, 95% CI 1.001-1.084, p=0.022). The amount of late gadolinium enhancement on cardiac magnetic resonance was an independent risk factor for adverse cardiovascular events in patients with stage C or D heart failure (HR 1.045 per 1% increase).
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