Prognostic value of multiple cardiac magnetic resonance imaging parameters in patients with idiopathic dilated cardiomyopathy
Introduction
Idiopathic dilated cardiomyopathy (IDCM) is one of the most common causes of heart failure (HF) and heart transplantation. Its actual 10-year survival rate is lower than 60% [[1], [2], [3]] and 1.9% of IDCM patients still suffer from death or heart transplantation each year [4]. Thus, effective risk stratification of IDCM patients is of great significance for clinical intervention guidance. Significant explore in this issue has been carried out recent years, especially those studies focused on cardiac magnetic resonance (CMR) parameters, which have been the hot spots in myocardial diseases. Nevertheless, in terms of the predictive value of these multiple CMR parameters for IDCM patients, their findings were inconsistent [[5], [6], [7], [8], [9], [10], [11], [12], [13]]. Studies have reported that the amount of late‑gadolinium enhancement (LGE) would increase incidence of major adverse cardiac events (MACEs) both in ischemic or non-ischemic dilated cardiomyopathy [[10], [11], [12], [13]]. Buss J and his team found that long-axis strain has high prognostic value in patients with IDCM in addition to LGE [6]. Additionally, global longitudinal strain (GLS) based on CMR feature tissue tracking provides potential significant benefit for risk stratification over LGE in IDCM patients [7,8]. However, a recently published study indicated that LGE, but not GLS, is a strong independent predictor in IDCM patients with moderately and severely reduced left ventricular ejection fraction (LVEF<40%) [9]. All of the studies agreed that LGE was a robust predictor of adverse cardiac events. Their divergence was whether GLS could predict MACEs and if its predictive value was better than that of LGE. Thus, the purpose of our study is to comprehensively explore the predictive value of these CMR parameters and clinical characters in IDCM patients with reduced LVEF(<40%).
Section snippets
Study population and design
Patients in our medical center who underwent standard gadolinium-enhanced CMR scanning to evaluate heart disease were retrospectively reviewed from Jan 2014 to Dec 2016. According to the guidelines of IDCM from World Health Organization and the American Heart Association, including criteria was patients with reduced LVEF (<40%) and ventricle enlargement. The excluding criteria were as follows: 1) ischemic heart disease which is defined as more than 50% coronary artery occlusion by invasive
Baseline characteristics of all subjects
A total of 126 IDCM patients with reduced LVEF were enrolled (Fig. S1), and the baseline characteristics of all enrolled subjects are shown in Table 1. The mean age of the overall study group was 49.9 ± 15.8(SD) years, and 69.8% of the sample was male. Table 2 presents the CMR parameters. In total, 66 (52.4%) patients presented with LGE. The mean LGE mass was 6.4 ± 12.2 g. The cardiac function of our studied sample was severely decreased, and the mean value of LVEF was 22.3 ± 8.1%.
Comparison between Patients with and without MACEs
During a
Discussion
In this study, we explored the association of adverse cardiac events with CMR parameters in IDCM patients with reduced LVEF. We found that NT-proBNP, LGE mass and percentage of LGE were reliable predictive factors for risk stratification in IDCM patients with reduced LVEF. Moreover, presence of LGE combined with NT-proBNP showed the strongest predictive value. Myocardial deformation indexes seemed to have no predictive value for MACEs in IDCM patients with reduced LVEF.
According to the heart
Limitations
Our study has some limitations. First, uncontrollable confounders may exist due to the retrospective study design. Second, we did not collect all subjects' survival information, and four patients were lost to follow-up in our study. Nevertheless, the rate of loss to follow-up was less than 5%. Third, our research lacks data on native T1 mapping of extracellular volume fraction (ECV), which can detect diffuse fibrosis quantitatively and is also associated with prognosis in HF and non-ischemic
Conclusion
In the present study, myocardial strain parameters evaluated by CMR feature tracking and LVEF seemed to have no prognostic value in IDCM patients with reduced LVEF. However, NT-proBN and extent of LGE are strong predictors of cardiac events in IDCM patients with reduced LVEF.. LGE combined with NT-proBNP have the best prognostic value in IDMC with reduced LVEF.
Declaration of Competing Interest
None declared.
Ackowledgement
None.
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- 1
Hang Fu, Huayan Xu, Lingyi Wen, are co-authors.
- 2
Yingkun Guo, Zhigang Yang contributed equally to this work and should be considered as co-corresponding authors.