title: Longitudinal strain combined with delayed-enhancement magnetic resonance improves risk stratification in patients with dilated cardiomyopathy.
abstract: Late gadolinium enhancement (LGE) on cardiac magnetic resonance (CMR) imaging has been reported to be associated with unfavourable outcomes; however, few studies have addressed the prognostic value of left ventricular (LV) deformation parameter indicated by global longitudinal strain (GLS) in two-dimensional speckle-tracking (2DST) echocardiography in patients with non-ischaemic dilated cardiomyopathy (DCM). This study aims to investigate whether the combination of GLS and LGE is useful in stratifying the risk in patients with DCM.
  
  
  
  We studied 179 consecutive symptomatic patients with DCM (age, 61±15 years; 121 males; left ventricular ejection fraction (LVEF) 33%±9%; New York Heart Association (NYHA) class II: n=71, III: n=107, IV: n=1) who underwent CMR and echocardiography with conventional assessment and 2DST analysis.
  
  
  
  There were 40 rehospitalisations for heart failure, including 7 cardiac deaths and 2 implantations of LV assist device during follow-up (3.8±2.5 years). Univariable Cox proportional hazard regression analysis showed that NYHA class, blood pressure, B-type natriuretic peptide, LV end-diastolic and end-systolic volumes, LVEF, left atrium volume, GLS and LGE were significantly associated with long-term outcome. Multivariable analysis revealed that GLS and LGE were independently associated with long-term outcome (p<0.05, both). In additional analyses, we found independent associations between GLS and LV reverse remodelling after the optimal medical therapy, and between LGE and life-threatening arrhythmias (p<0.05, both).
  
  
  
  Combining GLS and LGE could be useful for risk stratification and prognostic assessment in patients with DCM.
authors: Himeji Cardiovascular Center, Himeji, Japan.
authors: Misato
authors: M
authors: Chimura
authors: Himeji Cardiovascular Center, Himeji, Japan.
authors: Tetsuari
authors: T
authors: Onishi
authors: Himeji Cardiovascular Center, Himeji, Japan.
authors: Yasue
authors: Y
authors: Tsukishiro
authors: Himeji Cardiovascular Center, Himeji, Japan.
authors: Takahiro
authors: T
authors: Sawada
authors: Himeji Cardiovascular Center, Himeji, Japan.
authors: Kunihiko
authors: K
authors: Kiuchi
authors: Himeji Cardiovascular Center, Himeji, Japan.
authors: Akira
authors: A
authors: Shimane
authors: Himeji Cardiovascular Center, Himeji, Japan.
authors: Katsunori
authors: K
authors: Okajima
authors: Himeji Cardiovascular Center, Himeji, Japan.
authors: Shinichiro
authors: S
authors: Yamada
authors: Himeji Cardiovascular Center, Himeji, Japan.
authors: Yasuyo
authors: Y
authors: Taniguchi
authors: Himeji Cardiovascular Center, Himeji, Japan.
authors: Yoshinori
authors: Y
authors: Yasaka
authors: Himeji Cardiovascular Center, Himeji, Japan.
authors: Hiroya
authors: H
authors: Kawai
mesh_terms: D000368:Aged; D001696:Biomechanical Phenomena; D002311:Cardiomyopathy, Dilated / Q000000981:diagnostic imaging* / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D016009:Chi-Square Distribution; D003287:Contrast Media / Q000008:administration & dosage*; D018572:Disease-Free Survival; D018618:Echocardiography, Doppler, Color; D005260:Female; D019786:Gadolinium DTPA / Q000008:administration & dosage*; D006333:Heart Failure / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D006353:Heart-Assist Devices; D006801:Humans; D053208:Kaplan-Meier Estimate; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009200:Myocardial Contraction; D015588:Observer Variation; D010359:Patient Readmission; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D015203:Reproducibility of Results; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013314:Stress, Mechanical; D013318:Stroke Volume; D016277:Ventricular Function, Left; D020257:Ventricular Remodeling
chemical_list: D003287:Contrast Media; D019786:Gadolinium DTPA