title: Prognostic value of contrast-enhanced cardiac magnetic resonance imaging in patients with newly diagnosed non-ischemic cardiomyopathy: cohort study.
abstract: BACKGROUND
  Owing to its variable course from asymptomatic cases to sudden death risk stratification is of paramount importance in newly diagnosed non-ischemic cardiomyopathy. We tested whether late gadolinium enhancement (LGE) assessed by cardiac magnetic resonance (CMR) imaging is a prognostic marker in consecutive patients with newly diagnosed non-ischemic cardiomyopathy.
  
  
  METHODS
  We enrolled 185 patients who presented for evaluation of newly diagnosed non-ischemic cardiomyopathy. Coronary artery disease was excluded by coronary angiography. Following risk markers were additionally assessed: NYHA functional class (≥II), brain natriuretic peptide (>100 ng/l), troponin I (TnI, ≥0.03 µg/l), left ventricular ejection fraction (LVEF, ≤40%), left ventricular enddiastolic diameter (>55 mm) and QRS duration (>98 ms). Endpoint of the study was the composite of all-cause mortality, heart transplantation, aborted sudden death, sustained ventricular tachycardia or hospitalization due to decompensated heart failure within three years of follow-up.
  
  
  RESULTS
  During median follow-up of 21 months, 54 patients (29.2%) reached the composite endpoint. Ninety-four of the 185 patients (50.8%) were judged LGE-positive. Prognosis of LGE-positive patients was significantly worse than that of LGE-negative patients (cumulative 3-year event rates of 67.4% in LGE-positive and 27.2% in LGE-negative patients, respectively; p = 0.021). However, in multivariable analysis, presence of LGE was not an independent predictor of outcome. Only LVEF ≤40% and TnI ≥0.03 µg/l were independent risk predictors of the composite endpoint yielding relative risks of 3.9 (95% CI 1.9-8.1; p<0.0001) and 2.2 (95% CI 1.2-4.0; p = 0.014), respectively.
  
  
  CONCLUSIONS
  In consecutive patients presenting with newly diagnosed non-ischemic cardiomyopathy, LGE-positive patients had worse prognosis. However, only traditional risk parameters like left ventricular performance and cardiac biomarkers but not presence of LGE were independent risk predictors.
authors: Medizinische Klinik III, Kardiologie und Kreislauferkrankungen, Eberhard Karls University, Tübingen, Germany.
authors: Karin A L
authors: KA
authors: Müller
authors: Iris
authors: I
authors: Müller
authors: Ulrich
authors: U
authors: Kramer
authors: Reinhard
authors: R
authors: Kandolf
authors: Meinrad
authors: M
authors: Gawaz
authors: Axel
authors: A
authors: Bauer
authors: Christine S
authors: CS
authors: Zuern
mesh_terms: D000328:Adult; D000368:Aged; D009202:Cardiomyopathies / Q000175:diagnosis*; D003287:Contrast Media; D005260:Female; D005500:Follow-Up Studies; D005682:Gadolinium; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012307:Risk Factors
chemical_list: D003287:Contrast Media; D005682:Gadolinium