Prognostic significance of myocardial extracellular volume fraction in nonischaemic dilated cardiomyopathy.

Abstract

AIMS:

In nonischaemic dilated cardiomyopathy (NICM), replacement myocardial fibrosis as detected by late gadolinium enhancement (LGE) at cardiovascular magnetic resonance (CMR) is associated with poor prognosis. We investigated the as-yet unexplored prognostic significance of interstitial fibrosis in NICM, using T1-mapping CMR.

METHODS:

Eighty-nine NICM patients (63 men, age 59 ± 14 years) with left ventricular systolic dysfunction (ejection fraction 41 ± 13%) underwent comprehensive clinical and CMR evaluation, with extracellular volume fraction (ECV) estimation from pre and postcontrast T1 mapping. Fifteen healthy individuals (11 men, mean age 52 ± 11 years) were used as controls. The end-point was a composite of cardiovascular death, hospitalization for heart failure and appropriate defibrillator intervention.

RESULTS:

Myocardial ECV was higher in NICM patients (0.31 ± 0.05) than controls (0.25 ± 0.04, P < 0.01). In NICM patients, myocardial ECV correlated with left ventricular ejection fraction (R = 0.13), LGE extent (R = 0.17), Doppler E/E' (R = 0.17) and ventricular tachycardias (R = 0.21) at 24-h ECG monitoring (P < 0.05 for all). During a median follow-up of 24 months (interquartile range 12-42 months), 12 events occurred and higher myocardium ECV was independently associated with the occurrence of the composite end-point (P < 0.01).

CONCLUSION:

In NICM patients, myocardial ECV was increased compared with normal individuals, likely reflecting extracellular matrix remodelling and collagen deposition, and resulted an independent prognostic predictor beyond all other conventional clinical, electrocardiographic and echocardiographic parameters.

• Authors: Andrea Barison, Alberico Del Torto, Sara Chiappino, Giovanni Donato Aquaro, Giancarlo Todiere, Giuseppe Vergaro, Claudio Passino, Massimo Lombardi, Michele Emdin, Pier Giorgio Masci
• Journal: Journal of cardiovascular medicine (Hagerstown, Md.) (J Cardiovasc Med (Hagerstown)) Vol. 16 Issue 10 Pg. 681-7 (Oct 2015) ISSN: 1558-2035 [Electronic] United States
• PMID: 26090916 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Contrast Media

Topics

• Adult
• Aged
• Cardiomyopathies (physiopathology)
• Cardiomyopathy, Dilated (physiopathology)
• Case-Control Studies
• Contrast Media
• Echocardiography
• Female
• Heart Failure (physiopathology)
• Humans
• Linear Models
• Magnetic Resonance Imaging, Cine (methods)
• Male
• Middle Aged
• Multivariate Analysis
• Prognosis
• Prospective Studies
• Reproducibility of Results
• Stroke Volume (physiology)
• Survival Analysis
• Ventricular Dysfunction, Left (physiopathology)