Mid-wall striae fibrosis predicts heart failure admission, composite heart failure events, and life-threatening arrhythmias in dilated cardiomyopathy

Abstract

Heart failure (HF) admission is a dominant contributor to morbidity and healthcare costs in dilated cardiomyopathy (DCM). Mid-wall striae (MWS) fibrosis by late gadolinium enhancement (LGE) imaging has been associated with elevated arrhythmia risk. However, its capacity to predict HF-specific outcomes is poorly defined. We investigated its role to predict HF admission and relevant secondary outcomes in a large cohort of DCM patients. 719 patients referred for LGE MRI assessment of DCM were enrolled and followed for clinical events. Standardized image analyses and interpretations were conducted inclusive of coding the presence and patterns of fibrosis observed by LGE imaging. The primary clinical outcome was hospital admission for decompensated HF. Secondary heart failure and arrhythmic composite endpoints were also studied. Median age was 57 (IQR 47–65) years and median LVEF 40% (IQR 29–47%). Any fibrosis was observed in 228 patients (32%) with MWS fibrosis pattern present in 178 (25%). At a median follow up of 1044 days, 104 (15%) patients experienced the primary outcome, and 127 (18%) the secondary outcome. MWS was associated with a 2.14-fold risk of the primary outcome, 2.15-fold risk of the secondary HF outcome, and 2.23-fold risk of the secondary arrhythmic outcome. Multivariable analysis adjusting for all relevant covariates, inclusive of LVEF, showed patients with MWS fibrosis to experience a 1.65-fold increased risk (95% CI 1.11–2.47) of HF admission and 1-year event rate of 12% versus 7% without this phenotypic marker. Similar findings were observed for the secondary outcomes. Patients with LVEF > 35% plus MWS fibrosis experienced similar event rates to those with LVEF ≤ 35%. MWS fibrosis is a powerful and independent predictor of clinical outcomes in patients with DCM, identifying patients with LVEF > 35% who experience similar event rates to those with LVEF below this conventionally employed high-risk phenotype threshold.

Similarities and difference of cardiac function, structure, myocardial deformation, myocardial fibrosis between symptomatic peripartum cardiomyopathy at different clinical stage and dilated cardiomyopathy

“…This might be related to a more prevalent LGE distribution at middle wall of septal in DCM. Additionally, a recently published research with large sample size of DCM found that older DCM patients are more likely to show an mid wall LGE pattern, which was related to higher risk of HF readmission and adverse events [24]. Although age of DCM was similar to the whole PPCM cohort in our study, DCM patients tend to be older than acute PPCM.…”

Marfan Syndrome beyond Aortic Root—Phenotyping Using Cardiovascular Magnetic Resonance Imaging and Clinical Implications

“…However, up to 7% have LV dilatation without other features of idiopathic dilated cardiomyopathy [ 12 ]. Furthermore, there is a growing body of evidence that up to 8% of all MFS cases will develop secondary LV dysfunction due to significant valvular dysfunction (aortic or mitral valve regurgitation) or ischaemic heart disease, while primary LV dysfunction can be found in 3% of the MFS population [ 21 , 22 , 23 ].…”