Gadolinium cardiovascular magnetic resonance predicts reversible myocardial dysfunction and remodeling in patients with heart failure undergoing beta-blocker therapy.
BACKGROUND
In some patients with heart failure, beta-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 beta-blockers.


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 beta-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 beta-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 (P<0.001). For instance, contractility improved in 56% (674 of 1207) of regions with no scarring but in only 3% with >75% 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 (P=0.01), mean wall motion score (P=0.0007), LV end-diastolic volume index (P=0.007), and LV end-systolic volume index (P< or =0.0001).


CONCLUSIONS
For heart failure patients treated with beta-blockers, gadolinium-enhanced CMR predicts the response in LV function and remodeling.
Bello
David
D
Feinberg Cardiovascular Research Institute, Division of Cardiology, Northwestern University, Chicago, Ill, USA.
Shah
Dipan J
DJ
Farah
George M
GM
Di Luzio
Silvia
S
Parker
Michele
M
Johnson
Maryl R
MR
Cotts
William G
WG
Klocke
Francis J
FJ
Bonow
Robert O
RO
Judd
Robert M
RM
Gheorghiade
Mihai
M
Kim
Raymond J
RJ
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000368:Aged; D002921:Cicatrix / Q000175:diagnosis; D005682:Gadolinium; D006333:Heart Failure / Q000175:diagnosis* / Q000188:drug therapy / Q000503:physiopathology; D006571:Heterocyclic Compounds; D006801:Humans; D008279:Magnetic Resonance Imaging; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009200:Myocardial Contraction / Q000187:drug effects; D009942:Organometallic Compounds; D011237:Predictive Value of Tests; D011446:Prospective Studies; D020127:Recovery of Function / Q000187:drug effects; D013318:Stroke Volume / Q000187:drug effects; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis* / Q000188:drug therapy / Q000503:physiopathology; D020257:Ventricular Remodeling / Q000187:drug effects
D000319:Adrenergic beta-Antagonists; D006571:Heterocyclic Compounds; D009942:Organometallic Compounds; C062402:gadoteridol; D005682:Gadolinium