Predictors of left ventricular remodelling in patients with dilated cardiomyopathy – a cardiovascular magnetic resonance study

Abstract

Prospective study of patients with recent-onset DCM with cardiovascular magnetic resonance (CMR) assessment of ventricular structure and function, extracellular volume (T1 mapping), myocardial strain, myocardial scar (late gadolinium enhancement) and contractile reserve (dobutamine stress). Regression analyses were used to evaluate predictors of change in LV ejection fraction (LVEF) over 12 months. We evaluated 56 participants (34 DCM patients, median LVEF 43%; 22 controls). Absolute LV contractile reserve predicted change in LVEF (1% increase associated with 0.4% increase in LVEF at 12 months, P = 0.02). Baseline myocardial strain (P = 0.39 global longitudinal strain), interstitial myocardial fibrosis (P = 0.41), replacement myocardial fibrosis (P = 0.25), and right ventricular contractile reserve (P = 0.17) were not associated with LV reverse remodelling. There was a poor correlation between contractile reserve and either LV extracellular volume fraction (r = −0.22, P = 0.23) or baseline LVEF (r = 0.07, P = 0.62). Men were more likely to experience adverse LV remodelling (P = 0.01) but age (P = 0.88) and disease-modifying heart failure medication (beta-blocker, P = 0.28; angiotensin-converting enzyme inhibitor, P = 0.92) did not predict follow-up LVEF.

Effects of Levosimendan on cardiac function, size and strain in heart failure patients

“…On the other hand, Tayal et al failed to identify the measurement of cardiac structure or cardiac strain as a marker for LV LV recovery in DCM [32]. In their work, contractile reserve, as evidenced by dobutamine stress echocardiography, was predictive for a reduction in LV size [32]. In our cohort, we observed significantly smaller LV volumes after levosimendan infusion regardless of the presence of LV scarring in both groups.…”

“…On the one hand, the presence of LGE has been shown to be a negative predictor of LV reverse remodeling in non-ischemic CMP [31]. On the other hand, Tayal et al failed to identify the measurement of cardiac structure or cardiac strain as a marker for LV LV recovery in DCM [32]. In their work, contractile reserve, as evidenced by dobutamine stress echocardiography, was predictive for a reduction in LV size [32].…”

Factors predicting recovery of left ventricular dysfunction in non‐ischaemic cardiomyopathy

“…On the other hand, these patients often respond to cardiac resynchronization therapy (CRT) with improvement to normalization of LV function, highlighting the concept of electrical dyssynchrony as the major aetiological factor in a subset of patients with HF. In the current study by Tayal et al ., three patients have had a CRT device implanted and all showed a large improvement in LVEF. In addition to dyssynchronopathy, frequent premature ventricular contractions can lead to cardiac dysfunction, especially in patients with high arrhythmia burden and epicardial origin of the extra beats .…”

“…In this issue of the Journal, Tayal et al . present their results employing cardiac magnetic resonance imaging (CMR) combined with dobutamine stress testing to improve prediction of left ventricular (LV) functional recovery.…”

Sex-Specific Prognostic Implications in Dilated Cardiomyopathy After Left Ventricular Reverse Remodeling

“…Dilated cardiomyopathy (DCM) is a heterogeneous primary muscle disease predominantly affecting men, with a male to female ratio 3:1. The prognosis of DCM has dramatically improved over the last decades [1][2][3] and the occurrence of left ventricular reverse remodelling (LVRR) under optimal medical treatment has been shown as one of the main prognostic drivers [1,4,5].…”