Gadolinium Cardiovascular Magnetic Resonance Predicts Reversible Myocardial Dysfunction and Remodeling in Patients With Heart Failure Undergoing β-Blocker Therapy

Abstract

Background-In some patients with heart failure, ␤-blockers can improve left ventricular (LV) function and reduce morbidity and mortality. We hypothesized that gadolinium-enhanced cardiovascular magnetic resonance imaging (CMR) can predict reversible myocardial dysfunction and remodeling in heart failure patients treated with ␤-blockers. Methods and Results-Forty-five patients with chronic heart failure underwent CMR. Contrast imaging using gadolinium was performed to obtain high-resolution spatial maps of myocardial scarring and viability. Cine imaging was performed to assess LV function and morphology and was repeated in 35 patients after 6 months of ␤-blockade. Gadolinium CMR demonstrated scarring in 30 of 45 patients (67%). Scarring was found in 100% of patients with ischemic cardiomyopathy (28 of 28) but in only 12% with nonischemic cardiomyopathy (2 of 17). In the 35 patients who were maintained on ␤-blockers and had a second study, there was an inverse relation between the extent of scarring at baseline and the likelihood of contractile improvement 6 months later (PϽ0.001). For instance, contractility improved in 56% (674 of 1207) of regions with no scarring but in only 3% with Ͼ75% scarring (8 of 232). Multivariate analysis showed that the amount of dysfunctional but viable myocardium by CMR was an independent predictor of the change in ejection fraction (Pϭ0.01), mean wall motion score (Pϭ0.0007), LV end-diastolic volume index (Pϭ0.007), and LV end-systolic volume index (PՅ0.0001). Conclusions-For

Comparison of Mesenchymal Stem Cell Efficacy in Ischemic Versus Nonischemic Dilated Cardiomyopathy

“…Ischemic patients’ dysfunctional viable myocardium is limited by the area of scar, which contains very little viable tissue, whereas patients with DCM have a greater area of dysfunctional viable tissue free of scar 17. Previous analyses demonstrated that the increase in LV EF is related to a higher amount of dysfunctional viable tissue before treatment,41 correlating with our findings of improvement in LV systolic function among patients with DCM.…”

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

“…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.…”

“…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.…”

The emerging clinical role of cardiovascular magnetic resonance imaging

“…Other investigators confirmed the correlation of functional recovery with transmural extent of viable tissue in acute myocardial infarction (69) as well as in chronic ischemic disease (70,71). Equally, in chronic systolic heart failure, the recovery of function after initiation of beta-blocker therapy was shown to be a measure of the transmural extent of viable myocardium (72). CMR imaging is therefore a useful tool to assess stunned as well as hibernating (73) myocardium, when functional cine imaging is combined with late enhancement imaging.…”