Incremental Prognostic Value of Myocardial Fibrosis in Patients With Non–Ischemic Cardiomyopathy Without Congestive Heart Failure

Abstract

Background-We conducted a prospective longitudinal study to investigate the yet unknown clinical significance of myocardial fibrosis in patients with non-ischemic cardiomyopathy without history of congestive heart failure (CHF). Methods and Results-At 3 tertiary referral centers, 228 patients with non-ischemic cardiomyopathy without history of CHF were studied with cardiovascular magnetic resonance for late gadolinium enhancement (LGE) detection and quantification and prospectively followed up for a median of 23 months. The end point was a composite of cardiac death, onset of CHF, and aborted sudden cardiac death.LGE was detected in 61 (27%) patients. Thirty-one of 61 (51%) LGE addition to models, including clinical data alone or in combination with parameters of left ventricular remodeling and function, yielded an improvement in outcome prediction (P<0.001). Addition of LGE to age and left ventricular ejection fraction improved risk stratification for composite end point (net reclassification improvement, 29.6%) and onset of CHF (net reclassification improvement, 25.4%; both P<0.001). Conclusions-In patients with non-ischemic cardiomyopathy without history of CHF, myocardial fibrosis is a strong and independent predictor of outcome, providing incremental prognostic information and improvement in risk stratification beyond clinical data and degree of left ventricular dysfunction. (Circ Heart Fail. 2014;7:448-456.)

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.…”

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.…”

Cardiac fibroblasts in pressure overload hypertrophy: the enemy within?

“…Most importantly, the relevance of the findings by Moore-Morris et al for human heart disease and therapy remains to be determined (19,20). Undoubtedly, an improved understanding of cardiac fibroblast origin, fate, and interaction with other cell types in the heart as well as the complex roles of cardiac fibroblasts in cardiac development, function, and disease will be fundamental to our ability to use these cells as a future therapeutic tool.…”