Key result
Greater LGE extent linked to ~33% lower odds of LV reverse remodeling in recent-onset DCM.
Why the study?
Novel methods including CMR, cardiac biomarkers, and EMB results were evaluated to improve prediction of left ventricular reverse remodeling in recent-onset dilated cardiomyopathy.
Do baseline cardiac magnetic resonance and serial BNP testing predict left ventricular reverse remodeling in patients with recent-onset dilated cardiomyopathy?
Cohort (n=44)
Do baseline cardiac magnetic resonance and serial BNP testing predict left ventricular reverse remodeling in patients with recent-onset dilated cardiomyopathy?
Baseline CMR parameters (late gadolinium enhancement and myocardial edema) and serial BNP levels are superior to endomyocardial biopsy and conventional markers for predicting left ventricular reverse remodeling in recent-onset dilated cardiomyopathy.
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“The sample may only represent a subgroup of patients with subacute or chronic disease. The clinical onset of disease was beyond the time expected for acute myocarditis, also suggested by the observation that left ventricular size did not differ between inflammatory and idiopathic patients and by the lack of a difference with regard to markers of acute disease (high-sensitivity troponin T, viral genome presence, BNP, and C-reactive protein) between inflammatory and idiopathic cardiomyopathy as defined by biopsy. Therefore, the results may only be applicable in patients with suspected chronic inflammation as defined by biopsy.”
Baseline CMR may aid LVRR prediction in recent-onset DCM; hypothesis-generating and should not yet change practice or replace biopsy.
OBJECTIVES: This study aimed to evaluate the performance of cardiac magnetic resonance (CMR), cardiac biomarkers, and endomyocardial biopsy (EMB) results to predict left ventricular reverse remodeling (LVRR) in individuals with recent-onset dilated cardiomyopathy (DCM). BACKGROUND: LVRR is a marker of a favorable prognosis in individuals with recent-onset DCM. We used the aforementioned novel methods of prognostication to predict this event. METHODS: A total of 44 consecutive patients with recent-onset DCM underwent at baseline CMR, measurement of biomarkers and EMB together with conventional methods, including cardiopulmonary exercise testing and echocardiography. Measurement of B-type natriuretic peptide (BNP) and the cardiological examination were repeated at 3, 6, and 12 months. CMR was repeated at 12 months. LVRR was defined as an absolute increase in left ventricular ejection fraction from ≥10% to a final value of >35% accompanied by a decrease in left ventricular end-diastolic dimension ≥10% at 12 months of follow-up. RESULTS: LVRR was observed in 20 individuals (45%) at 12 months. At baseline, a lower extent of late gadolinium enhancement (odds ratio [OR]: 0.67 [95% confidence interval (CI): 0.50 to 0.90]; p = 0.008) and a higher myocardial edema ratio (OR: 1.45 [95% CI: 1.04 to 2.02]; p = 0.027) measured by CMR were independent predictors of LVRR. At 3 months, the latest BNP plasma level (OR: 0.14 [95% CI: 0.02 to 0.94] per log BNP; p = 0.047) was the strongest predictor of LVRR. CONCLUSIONS: Both CMR and serial BNP testing provide a better prediction of LVRR in recent-onset DCM than EMB results, other biomarkers, and the conventional methods of follow-up.
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Kubánek et al. (2012) conducted a cohort in Recent-onset dilated cardiomyopathy (DCM) (n=44). Cardiac magnetic resonance (late gadolinium enhancement and myocardial edema ratio) and BNP testing vs. Endomyocardial biopsy (EMB) and conventional methods was evaluated on Left ventricular reverse remodeling (LVRR) at 12 months (OR 0.67, 95% CI 0.50 to 0.90, p=0.008). A lower extent of late gadolinium enhancement (OR 0.67; 95% CI 0.50-0.90) and higher myocardial edema ratio independently predicted left ventricular reverse remodeling in recent-onset DCM.
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