Association of Fibrosis With Mortality and Sudden Cardiac Death in Patients With Nonischemic Dilated Cardiomyopathy

Gulati, Ankur; Jabbour, Andrew; Ismail, Tevfik F; Guha, Kaushik; Khwaja, Jahanzaib; Raza, Sadaf; Morarji, Kishen; Brown, Tristan; Ismail, Nizar; Dweck, Marc R; Pietro, Elisa Di; Roughton, Michael; Wage, Ricardo; Daryani, Yousef; O’Hanlon, Rory; Sheppard, Mary N.; Alpendurada, Francisco; Lyon, Alexander R.; Cook, Stuart A.; Cowie, Martin R.; Assomull, Ravi; Pennell, Dudley J.; Prasad, Sanjay

doi:10.1001/jama.2013.1363

Cited by 971 publications

(816 citation statements)

References 51 publications

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“…The overall favorable prognosis of PPCM where most women recover systolic function and fare well2 suggests a low prevalence of LGE. Yet, a recent study by Haghikia and colleagues reported an unexpectedly high prevalence of LGE (71%)3 in PPCM, which greatly exceeds the ≈30% prevalence of LGE reported in large case series of dilated cardiomyopathy patients 4. The reported high prevalence of LGE in PPCM appears at odds with the clinical course of PPCM as well as prior reports from smaller PPCM case series 5, 6, 7.…”

Section: Introductionmentioning

confidence: 77%

“…CMR has emerged as an important tool to identify the etiology of nonischemic cardiomyopathies,27 and predict risk of adverse outcomes based on the extent of LGE 4, 8, 10, 14, 15, 27. LGE can detect foci of myocardial damage as small as 0.7 g of myocardial tissue 28.…”

Section: Discussionmentioning

confidence: 99%

“…Since LGE indicates irreversible focal myocardial damage, even when ejection fraction is preserved,8, 9, 10 the overall low prevalence of LGE in this study represents an optimistic finding. Indeed, the CMR literature consistently indicates that LGE is associated with persistent myocardial dysfunction despite medical therapy,11, 12 arrhythmia,4, 13, 14 and in turn, adverse clinical events such as hospitalization for heart failure, arrhythmia, and mortality 4, 8, 10, 14, 15. In the setting of severe heart failure from PPCM, the low prevalence of LGE might inform decision making when contemplating advanced heart failure therapies such as mechanical circulatory support as a bridge to recovery and heart transplantation.…”

Section: Discussionmentioning

confidence: 99%

“…While LGE can occur even when ejection fraction is preserved,8, 9, 10 LGE is generally associated with persistent myocardial dysfunction despite medical therapy,11, 12 arrhythmia,4, 13, 14 and in turn, hospitalization for heart failure, arrhythmia, and mortality 4, 8, 10, 14, 15. Regardless of etiology, LGE is prognostically adverse across the spectrum of left ventricular ejection fraction (LVEF), even when preserved 4, 8, 9, 10.…”

Section: Introductionmentioning

confidence: 99%

“…Regardless of etiology, LGE is prognostically adverse across the spectrum of left ventricular ejection fraction (LVEF), even when preserved 4, 8, 9, 10. LGE detects foci of irreversible myocardial damage manifest by enhancement, regardless of the mechanism or the timing of injury.…”

Section: Introductionmentioning

confidence: 99%

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Myocardial Damage Detected by Late Gadolinium Enhancement Cardiac Magnetic Resonance Is Uncommon in Peripartum Cardiomyopathy

Schelbert

Elkayam

Cooper

et al. 2017

JAHA

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BackgroundIn peripartum cardiomyopathy, the prevalence of focal myocardial damage detected by late gadolinium enhancement (LGE) cardiovascular magnetic resonance is important to elucidate mechanisms of myocardial injury and cardiac dysfunction. LGE equates irreversible myocardial injury, but LGE prevalence in peripartum cardiomyopathy is uncertain.Methods and ResultsAmong 100 women enrolled within the Investigations of Pregnancy Associated Cardiomyopathy cohort, we recruited 40 women at 13 centers to undergo LGE cardiovascular magnetic resonance, enrolled within the first 13 weeks postpartum. Follow‐up scans occurred at 6 months postpartum, and death/transplant rates at 12 months. Baseline characteristics did not differ significantly in the parent cohort according to cardiovascular magnetic resonance enrollment except for mechanical circulatory support. LGE was noted only in 2 women (5%) at baseline. While left ventricular dysfunction with enlargement was prevalent at baseline cardiovascular magnetic resonance scans (eg, ejection fraction 38% [Q1–Q3 31–50%], end diastolic volume index=108 mL/m2 [Q1–Q3 83–134 mL/m2]), most women demonstrated significant improvements at 6 months, consistent with a low prevalence of LGE. LGE was not related to baseline clinical variables, ejection fraction, New York Heart Association heart failure class, or mortality. Neither of the 2 women who died exhibited LGE. LGE was inversely associated with persistent left ventricular ejection fraction at 6 months (P=0.006).ConclusionsFactors other than focal myocardial damage detectable by LGE explain the initial transient depressions in baseline left ventricular ejection fraction, yet focal myocardial damage may contribute to persistent myocardial dysfunction and hinder recovery in a small minority. Most women exhibit favorable changes in ventricular function over 6 months.Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT01085955.

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