title: Characteristics and prognostic importance of myocardial fibrosis in patients with dilated cardiomyopathy assessed by contrast-enhanced cardiac magnetic resonance imaging.
abstract: BACKGROUND
  Dilated cardiomyopathy (DCM) is associated with significant morbidity and mortality. Contrast-enhanced cardiac MRI (CE-CMR) can detect potentially prognostic myocardial fibrosis in DCM. We investigated the role of CE-CMR in New Zealand patients with DCM, both Maori and non-Maori, including the characteristics and prognostic importance of fibrosis.
  
  
  METHODS
  One hundred and three patients (mean age 58 ± 13, 78 male) referred for CMR assessment of DCM were followed for 660 ± 346 days. Major adverse cardiac events (MACE) were defined as death, infarction, ventricular arrhythmias or rehospitalisation. CE-CMR used cines for functional analysis, and delayed enhancement to assess fibrosis.
  
  
  RESULTS
  Myocardial fibrosis was present in 30% of patients, the majority of which was mid-myocardial (63%). Volumetric parameters were similar in patients with or without fibrosis. At 2 years patients with fibrosis had an increased rate of MACE (HR = 0.77, 95% CI 0.3-2.0). Patients with full thickness or subendocardial fibrosis had the highest MACE, even in the absence of CAD). More Maori had fibrosis on CE-CMR (40% vs. 28% for non-Maori), and the majority (75%) was mid-myocardial. Maori and non-Maori had similar outcomes (25% vs. 24% with events during follow-up).
  
  
  CONCLUSIONS
  DCM patients frequently have myocardial fibrosis detected on CE-CMR, the majority of which is mid-myocardial. Fibrosis is associated with worse outcome in the medium term. The information obtained using CE-CMR in DCM may be of incremental clinical benefit.
authors.affiliation: Cardiovascular Division, North Shore Hospital, Takapuna, Auckland, New Zealand.
authors.forename: Jen-Li
authors.initials: JL
authors.lastname: Looi
authors.forename: Colin
authors.initials: C
authors.lastname: Edwards
authors.forename: Guy P
authors.initials: GP
authors.lastname: Armstrong
authors.forename: Anthony
authors.initials: A
authors.lastname: Scott
authors.forename: Hitesh
authors.initials: H
authors.lastname: Patel
authors.forename: Hamish
authors.initials: H
authors.lastname: Hart
authors.forename: Jonathan P
authors.initials: JP
authors.lastname: Christiansen