Baseline cardiac magnetic resonance imaging versus baseline endomyocardial biopsy for the prediction of left ventricular reverse remodeling and prognosis in response to therapy in patients with idiopathic dilated cardiomyopathy

Abstract

Endomyocardial biopsy (EMB) and late gadolinium enhancement cardiovascular magnetic resonance (LGE-CMR) imaging performed at baseline are both used to evaluate the extent of myocardial fibrosis. However, no study has directly compared the effectiveness of these diagnostic tools in the prediction of left ventricular reverse remodeling (LVRR) and prognosis in response to therapy in patients with idiopathic dilated cardiomyopathy (IDCM). Seventy-five patients with newly diagnosed IDCM who were undergoing optimal therapy were assessed at baseline using LGE-CMR imaging and EMB; the former measured LGE area and the latter measured collagen volume fraction (CVF) as possible predictive indices of LVRR and cardiac event-free survival. Among all the baseline primary candidate factors with P < 0.2 as per univariate analysis, multivariate analysis indicated that only LGE area was an independent predictor of subsequent LVRR (β = 0.44; 95 % confidence interval (CI) 0.87–2.53; P < 0.001), as indicated by decreasing left ventricular end-systolic volume index over the 1-year follow-up. Kaplan–Meier curves indicated significantly lower cardiac event-free survival rates in patients with LGE at baseline than in patients without (P < 0.01). By contrast, there was no significant difference in prognosis between patients with CVF values above (severe fibrosis) and below (mild fibrosis) the median of 4.9 %. Cox proportional hazard analysis showed that LGE area was an independent predictor of subsequent cardiac events (hazard ratio 1.06; 95 % CI 1.02–1.10; P ≤ 0.01). The degree of myocardial fibrosis estimated by baseline LGE-CMR imaging, but not that estimated by baseline EMB, can predict LVRR and cardiac event-free survival in response to therapy in patients with newly diagnosed IDCM.

Prognostic Impact of Segmental Wall Motion Abnormality in Patients With Idiopathic Dilated Cardiomyopathy

“…LGE-CMR imaging can detect the presence and extent of myocardial fibrosis possibly leading to SWMA. 13,14) However, our study did not show a significant difference in the LGE-CMR findings between the SWMA+ and SWMA-groups. To compare individually the region of SWMA by LVG and the LGEpositive area by CMR in this study, SWMA corresponded to LGE in some areas but not in other regions (data not shown).…”

Late Gadolinium Enhancement and the Risk for Ventricular Arrhythmias or Sudden Death in Dilated Cardiomyopathy

“…The majority of studies evaluated the presence or absence of LGE by visual analysis. 4,6,7,10,[13][14][15][16][17][18][19][20]22,[24][25][26][27][28][29]30,32 Duration of follow-up ranged from 1 year to 5.3 years; mean follow up was 3 years. The majority of reports considered a composite arrhythmic end-point formed by sudden cardiac death and/or aborted cardiac arrest, sustained ventricular arrhythmias and/or appropriate ICD therapies.…”

Multimodality imaging assessment of mitral valve anatomy in planning for mitral valve repair in secondary mitral regurgitation

“…The contrast-enhanced T1 mapping provides quantification of the degree of (146). Importantly, the extent of fibrosis, focal and/or diffuse, determines in part the likelihood of positive remodeling in response to treatment, suggesting that fibrosis might be used for risk stratification and decision making (147)(148)(149)(150)(151). Therefore, the extend and progression of cardiac fibrosis, as a consequence of myocardial infarction and/or chronic volume overload in patients with secondary MR, could be used as risk marker in this population: the benefit of intervention may be variable according to the presence and amount of fibrosis, as well as its progression over time.…”