Cardiovascular magnetic resonance, fibrosis, and prognosis in dilated cardiomyopathy.
OBJECTIVE
We studied the prognostic implications of midwall fibrosis in dilated cardiomyopathy (DCM) in a prospective longitudinal study.


BACKGROUND
Risk stratification of patients with nonischemic DCM in the era of device implantation is problematic. Approximately 30% of patients with DCM have midwall fibrosis as detected by late gadolinium-enhancement (LGE) cardiovascular magnetic resonance (CMR), which may increase susceptibility to arrhythmia and progression of heart failure.


METHODS
Consecutive DCM patients (n = 101) with the presence or absence of midwall fibrosis were followed up prospectively for 658 +/- 355 days for events.


RESULTS
Midwall fibrosis was present in 35% of patients and was associated with a higher rate of the predefined primary combined end point of all-cause death and hospitalization for a cardiovascular event (hazard ratio 3.4, p = 0.01). Multivariate analysis showed midwall fibrosis as the sole significant predictor of death or hospitalization. However, there was no significant difference in all-cause mortality between the 2 groups. Midwall fibrosis also predicted secondary outcome measures of sudden cardiac death (SCD) or ventricular tachycardia (VT) (hazard ratio 5.2, p = 0.03). Midwall fibrosis remained predictive of SCD/VT after correction for baseline differences in left ventricular ejection fraction between the 2 groups.


CONCLUSIONS
In DCM, midwall fibrosis determined by CMR is a predictor of the combined end point of all-cause mortality and cardiovascular hospitalization, which is independent of ventricular remodeling. In addition, midwall fibrosis by CMR predicts SCD/VT. This suggests a potential role for CMR in the risk stratification of patients with DCM, which may have value in determining the need for device therapy.
Assomull
Ravi G
RG
Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London, United Kingdom.
Prasad
Sanjay K
SK
Lyne
Jonathan
J
Smith
Gillian
G
Burman
Elizabeth D
ED
Khan
Mohammed
M
Sheppard
Mary N
MN
Poole-Wilson
Philip A
PA
Pennell
Dudley J
DJ
D000328:Adult; D000368:Aged; D002102:Cadaver; D002311:Cardiomyopathy, Dilated / Q000150:complications / Q000175:diagnosis* / Q000401:mortality* / Q000628:therapy; D016757:Death, Sudden, Cardiac / Q000209:etiology; D005260:Female; D005355:Fibrosis; D006760:Hospitalization; D006801:Humans; D016014:Linear Models; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000473:pathology*; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D016019:Survival Analysis; D017180:Tachycardia, Ventricular / Q000209:etiology