Characteristics and Prognostic Importance of Myocardial Fibrosis in Patients with Dilated Cardiomyopathy Assessed by Contrast-Enhanced Cardiac Magnetic Resonance Imaging

Abstract

IntroductionDilated cardiomyopathy (DCM) is associated with significant morbidity and mortality. Contrast-enhanced cardiac MRI (CE-CMR) can detect potentially prognostic myocardial fibrosis in DCM. We investigated the role of CE-CMR in New Zealand patients with DCM, both Maori and non-Maori, including the characteristics and prognostic importance of fibrosis.MethodsOne hundred and three patients (mean age 58 ± 13, 78 male) referred for CMR assessment of DCM were followed for 660 ± 346 days. Major adverse cardiac events (MACE) were defined as death, infarction, ventricular arrhythmias or rehospitalisation. CE-CMR used cines for functional analysis, and delayed enhancement to assess fibrosis.ResultsMyocardial fibrosis was present in 30% of patients, the majority of which was mid-myocardial (63%). Volumetric parameters were similar in patients with or without fibrosis. At 2 years patients with fibrosis had an increased rate of MACE (HR = 0.77, 95% CI 0.3–2.0). Patients with full thickness or subendocardial fibrosis had the highest MACE, even in the absence of CAD). More Maori had fibrosis on CE-CMR (40% vs. 28% for non-Maori), and the majority (75%) was mid-myocardial. Maori and non-Maori had similar outcomes (25% vs. 24% with events during follow-up).ConclusionsDCM patients frequently have myocardial fibrosis detected on CE-CMR, the majority of which is mid-myocardial. Fibrosis is associated with worse outcome in the medium term. The information obtained using CE-CMR in DCM may be of incremental clinical benefit.

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.…”

“…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. 4,5,7,8,10,13,14,[16][17][18]20,22,25,[28][29][30][31] In two reports history of arrhythmic events was the end-point analyzed. 9,32 These data were not used to calculate annual event rates, but were included in the evaluation of pooled OR.…”

TLR3 deficiency induces chronic inflammatory cardiomyopathy in resistant mice following coxsackievirus B3 infection: role for IL-4

“…Extracellular matrix remodeling and fibrosis are critical for the progression from CVB3 myocarditis to DCM (13,36,43). Fibroblast proliferation and collagen deposition can be increased by TNF, IL-1␤, IL-4, IL-13, IL-17A, and/or TGF-␤ 1 (7,13,18,40).…”

Prognostic value of late gadolinium enhancement in dilated cardiomyopathy patients: a meta-analysis

“…Of the remaining 26 potentially appropriate studies, four did not contain specific outcomes, four did not present enough data for extraction, and five were reviews. Finally, 13 studies were included in the meta-analysis (Fig 1); among them, two, by Looi et al 20 and Machii et al 21 were retrospective, whereas the remaining 11 were all prospective cohort studies.…”