title: Prognostic significance of myocardial extracellular volume fraction in nonischaemic dilated cardiomyopathy.
abstract: OBJECTIVE
  In nonischaemic dilated cardiomyopathy (NICM), replacement myocardial fibrosis as detected by late gadolinium enhancement (LGE) at cardiovascular magnetic resonance (CMR) is associated with poor prognosis. We investigated the as-yet unexplored prognostic significance of interstitial fibrosis in NICM, using T1-mapping CMR.
  
  
  METHODS
  Eighty-nine NICM patients (63 men, age 59 ± 14 years) with left ventricular systolic dysfunction (ejection fraction 41 ± 13%) underwent comprehensive clinical and CMR evaluation, with extracellular volume fraction (ECV) estimation from pre and postcontrast T1 mapping. Fifteen healthy individuals (11 men, mean age 52 ± 11 years) were used as controls. The end-point was a composite of cardiovascular death, hospitalization for heart failure and appropriate defibrillator intervention.
  
  
  RESULTS
  Myocardial ECV was higher in NICM patients (0.31 ± 0.05) than controls (0.25 ± 0.04, P < 0.01). In NICM patients, myocardial ECV correlated with left ventricular ejection fraction (R = 0.13), LGE extent (R = 0.17), Doppler E/E' (R = 0.17) and ventricular tachycardias (R = 0.21) at 24-h ECG monitoring (P < 0.05 for all). During a median follow-up of 24 months (interquartile range 12-42 months), 12 events occurred and higher myocardium ECV was independently associated with the occurrence of the composite end-point (P < 0.01).
  
  
  CONCLUSIONS
  In NICM patients, myocardial ECV was increased compared with normal individuals, likely reflecting extracellular matrix remodelling and collagen deposition, and resulted an independent prognostic predictor beyond all other conventional clinical, electrocardiographic and echocardiographic parameters.
authors.affiliation: aFondazione Toscana Gabriele Monasterio bScuola Superiore Sant'Anna, Pisa cI.R.C.C.S Policlinico San Donato, San Donato, Milanese, Italy dBiomedical Sciences, Katholieke Universiteit, Leuven, Belgium.
authors.forename: Andrea
authors.initials: A
authors.lastname: Barison
authors.forename: Alberico
authors.initials: A
authors.lastname: Del Torto
authors.forename: Sara
authors.initials: S
authors.lastname: Chiappino
authors.forename: Giovanni Donato
authors.initials: GD
authors.lastname: Aquaro
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Todiere
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Vergaro
authors.forename: Claudio
authors.initials: C
authors.lastname: Passino
authors.forename: Massimo
authors.initials: M
authors.lastname: Lombardi
authors.forename: Michele
authors.initials: M
authors.lastname: Emdin
authors.forename: Pier Giorgio
authors.initials: PG
authors.lastname: Masci
mesh_terms: D000328:Adult; D000368:Aged; D009202:Cardiomyopathies / Q000503:physiopathology*; D002311:Cardiomyopathy, Dilated / Q000503:physiopathology*; D016022:Case-Control Studies; D003287:Contrast Media; D004452:Echocardiography; D005260:Female; D006333:Heart Failure / Q000503:physiopathology*; D006801:Humans; D016014:Linear Models; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D011446:Prospective Studies; D015203:Reproducibility of Results; D013318:Stroke Volume / Q000502:physiology*; D016019:Survival Analysis; D018487:Ventricular Dysfunction, Left / Q000503:physiopathology*
chemical_list: D003287:Contrast Media