title: Cardiovascular magnetic resonance, fibrosis, and prognosis in dilated cardiomyopathy.
abstract: 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.
authors.affiliation: Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London, United Kingdom.
authors.forename: Ravi G
authors.initials: RG
authors.lastname: Assomull
authors.forename: Sanjay K
authors.initials: SK
authors.lastname: Prasad
authors.forename: Jonathan
authors.initials: J
authors.lastname: Lyne
authors.forename: Gillian
authors.initials: G
authors.lastname: Smith
authors.forename: Elizabeth D
authors.initials: ED
authors.lastname: Burman
authors.forename: Mohammed
authors.initials: M
authors.lastname: Khan
authors.forename: Mary N
authors.initials: MN
authors.lastname: Sheppard
authors.forename: Philip A
authors.initials: PA
authors.lastname: Poole-Wilson
authors.forename: Dudley J
authors.initials: DJ
authors.lastname: Pennell
mesh_terms: 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