title: Right ventricular dysfunction, late gadolinium enhancement, and female gender predict poor outcome in patients with dilated cardiomyopathy.
abstract: OBJECTIVE
  Dilated cardiomyopathy (DCM) shows a variable disease course and is associated with significant morbidity and mortality. So far, left ventricular function (LVF) is the major determinant for risk stratification. However, since it has shown to be a poor guide to individual outcome, we studied the prognostic value of cardiovascular magnetic resonance imaging (CMR) parameters, late gadolinium enhancement (LGE) and epicardial adipose tissue (EAT).
  
  
  RESULTS
  140 patients with DCM underwent late gadolinium enhancement (LGE) CMR. During a median follow-up of 3 years, 22 patients (16%) died and another 51 (36%) were hospitalized due to congestive heart failure (CHF). Female gender and right ventricular ejection fraction (RV-EF) below the median of 38% were independent predictors of all-cause mortality in multivariable analysis. In patients who were hospitalized due to CHF, RV-EF below the median of 38% was the only independent predictor in multivariable analysis. When patients where further stratified according to systolic LV-EF, the prognostic value of RV-EF to predict mortality and cardiac morbidity remained unchanged. Looking at DCM patients who died during follow-up compared to those who were hospitalized due to CHF, the former presented with a higher prevalence of LGE as well as reduced indexed EAT.
  
  
  CONCLUSIONS
  Female gender, RV-EF and the presence of LGE are of prognostic importance in patients with DCM. Therefore, the present study underlines the role of CMR as an important tool for risk stratification in patients with DCM.
authors.affiliation: 1st Department of Medicine, Cardiology, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Germany; DZHK (German Centre for Cardiovascular Research) partner site, Mannheim, Germany. Electronic address: Christina.Doesch@umm.de.
authors.forename: Christina
authors.initials: C
authors.lastname: Doesch
authors.affiliation: 1st Department of Medicine, Cardiology, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Germany.
authors.forename: Désirée-Marie
authors.initials: DM
authors.lastname: Dierks
authors.affiliation: 1st Department of Medicine, Cardiology, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Germany; DZHK (German Centre for Cardiovascular Research) partner site, Mannheim, Germany.
authors.forename: Dariusch
authors.initials: D
authors.lastname: Haghi
authors.affiliation: 1st Department of Medicine, Cardiology, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Germany; DZHK (German Centre for Cardiovascular Research) partner site, Mannheim, Germany.
authors.forename: Rainer
authors.initials: R
authors.lastname: Schimpf
authors.affiliation: 1st Department of Medicine, Cardiology, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Germany; DZHK (German Centre for Cardiovascular Research) partner site, Mannheim, Germany.
authors.forename: Jürgen
authors.initials: J
authors.lastname: Kuschyk
authors.affiliation: 1st Department of Medicine, Cardiology, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Germany; DZHK (German Centre for Cardiovascular Research) partner site, Mannheim, Germany.
authors.forename: Tim
authors.initials: T
authors.lastname: Suselbeck
authors.affiliation: Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Germany; DZHK (German Centre for Cardiovascular Research) partner site, Mannheim, Germany.
authors.forename: Stefan O
authors.initials: SO
authors.lastname: Schoenberg
authors.affiliation: 1st Department of Medicine, Cardiology, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Germany; DZHK (German Centre for Cardiovascular Research) partner site, Mannheim, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Borggrefe
authors.affiliation: 1st Department of Medicine, Cardiology, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Germany; DZHK (German Centre for Cardiovascular Research) partner site, Mannheim, Germany.
authors.forename: Theano
authors.initials: T
authors.lastname: Papavassiliu
mesh_terms: D000328:Adult; D002311:Cardiomyopathy, Dilated / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology*; D005260:Female; D005682:Gadolinium; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012727:Sex Characteristics; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome; D018497:Ventricular Dysfunction, Right / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology*
chemical_list: D005682:Gadolinium
keywords: Cardiovascular magnetic resonance imaging; Dilated cardiomyopathy; Right ventricular ejection fraction; Risk stratification