title: Is there a role for diastolic function assessment in era of delayed enhancement cardiac magnetic resonance imaging?: a multimodality imaging study in patients with advanced ischemic cardiomyopathy.
abstract: Cardiac magnetic resonance (CMR) identifies important prognostic variables in ischemic cardiomyopathy (ICM) patients such as left ventricular (LV) volumes, LV ejection fraction (LVEF), peri-infarct zone, and myocardial scar burden (MSB). It is unknown whether Doppler-based diastolic dysfunction (DDF) retains its prognostic value in ICM patients, in the context of current imaging, medical, and device therapies.
  
  
  METHODS
  Diastolic function was evaluated in ICM patients (LVEF ≤ 40% and ≥ 70% stenosis in ≥ 1 coronary artery) who underwent transthoracic echocardiogram and delayed hyperenhancement CMR studies within 7 days. The association of DDF with the combined end point was assessed after risk-adjustment using Cox proportional hazards models.
  
  
  RESULTS
  A total of 360 patients with severe LV dysfunction (LVEF = 24 ± 9%) and extensive MSB (31 ± 17%) were evaluated; DDF was present in all patients (stage 1%-44%, stage 2%-25%, stage 3%-31%). There were 130 events (124 deaths and 6 heart transplants) over a median follow-up of 5.8 years (IQR, 3.7-7.4 years). On multivariable analysis, DDF > stage 1 (HR, 1.37; P = .007) was associated with the combined end-point, independent of clinical risk score (HR, 2.40; P < .0001), implantable cardioverter defibrillator implantation (HR, 0.60; P = .009), incomplete revascularization (HR, 1.32; P = .003), mitral regurgitation (HR, 3.37; P = .01), peri-infarct zone area (HR, 1.04; P = 0.02), and MSB (HR, 1.02; P = .01). DDF had incremental prognostic value for the combined end-point (model χ(2) increased from 89 to 95, P = .02).
  
  
  CONCLUSIONS
  DDF is a powerful predictor of mortality in ICM patients with significant LV dysfunction, independent of clinical and CMR data. DDF assessment provides incremental value, improving risk stratification.
authors: Heart and Vascular Institute, University of Pittsburgh-UPMC, Pittsburgh, PA.
authors: João L
authors: JL
authors: Cavalcante
authors: Menzies Research Institute of Tasmania, Hobart, Australia.
authors: Thomas H
authors: TH
authors: Marwick
authors: Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, OH.
authors: Rory
authors: R
authors: Hachamovitch
authors: Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, OH.
authors: Zoran B
authors: ZB
authors: Popovic
authors: Allegheny General Hospital, Pittsburgh, PA.
authors: Nael
authors: N
authors: Aldweib
authors: Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, OH.
authors: Randall C
authors: RC
authors: Starling
authors: Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, OH.
authors: Milind Y
authors: MY
authors: Desai
authors: Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, OH.
authors: Scott D
authors: SD
authors: Flamm
authors: Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, OH. Electronic address: kwond@ccf.org.
authors: Deborah H
authors: DH
authors: Kwon
mesh_terms: D009202:Cardiomyopathies / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology*; D002921:Cicatrix / Q000473:pathology; D003287:Contrast Media; D023921:Coronary Stenosis; D003971:Diastole / Q000502:physiology; D005260:Female; D006801:Humans; D007089:Image Enhancement; D053208:Kaplan-Meier Estimate; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction; D017202:Myocardial Ischemia / Q000473:pathology / Q000503:physiopathology; D009206:Myocardium / Q000473:pathology; D011379:Prognosis; D016016:Proportional Hazards Models; D018570:Risk Assessment; D014463:Ultrasonography; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology
chemical_list: D003287:Contrast Media