A Series Of Clinical Studies On The Prognosis Of Dilated Cardiomyopathy By Magnetic Resonance Imaging

Aims:The goal of this study was to evaluate the differential value and of cardiac magnetic resonance (CMR) in large Chinese dilated cardiomyopathy (DCM) population and investigate the role of myocardial fibrosis detected by Late Gadolinium Enhancement (LGE) on left ventricular remodeling and clinical outcome during the mid-term follow up.Methods:707 consecutive patients with first clinical diagnosis of DCM from July 2009 to December 2011 were examined with CMR and 519 patients met the enrolment criteria in the final cohort. Patients were classified into Group LGE(+) and Group LGE(-) according to the presence of LGE. Differences between groups were compared and cardiac adverse events were recorded. The end point was defined as a composite of hospitalisation for decompensated congestive heart failure, appropriate implantable cardioverter-defibrillator (ICD) discharge or cardiac resynchronization therapy defibrillator (CRT-D), cardiac death and heart transplantation. Survival curves were conducted by the Kaplan-Meier method and compared by the log-rank test. Univariate and multivariate Cox proportional hazards regression analysis was performed to calculate hazard ratios (HR) and identify the independent predictor of adverse outcome.Results:Of the total 519 patients, mean age was 45.3±14.8 years(age extent from 9 to 80 years) and 400 patients (77.1%) were male. Myocardial fibrosis visualized by LGE was detected in 213 patients.149 patients of the LGE (+) group exhibited a midwall enhancement, while 40 showed a patchy enhancement pattern and 23 diffuse enhancement pattern. There were no statistically significant differences between the two groups in baseline characteristics except lower BMI (p=0.001) and higher NYHA functional class (p<0.001), history of smoking (p=0.001), aldosterone antagonist (p=0.006) and Digoxin (p=0.04) in LGE (+) patients. In CMR results, LGE (+) patients showed significantly decreased LVEF(22.9±8.9 vs.27.9±7.5,p<0.001) and increased LVEDV (p<0.001), LVESV (p<0.001), LVEDVI (p<0.001), LVESVI (p<0.001) compared with LGE (-) patients. During the follow-up period, the incidence of cardiac events was significantly higher in patients with LGE than that without LGE (36.2% vs.16.3%, p<0.001). The Kaplan-Meier analysis showed a significantly worse outcome during follow-up among LGE (+) group than in LGE (-) group (log rank, p<0.001). Cox regression analysis identified the presence of LGE as the strongest predictor (p<0.001, HR=1.74).Conclusions:CMR can provide effective and comprehensive imaging evidence for the exclusion diagnosis of ACM. The presence of myocardial fibrosis detected by LGE was associated with pronounced left ventricular remodelling and worse outcome in Chinese patients with DCM. LGE was independent predictor of adverse cardiac events.Aims:The aim of this retrospective study was to evaluate the differential value of cardiac magnetic resonance imaging (CMR) on exclusion diagnosis of alcoholic cardiomyopathy (ACM) and determine the independent predictor of adverse cardiac events by analyzing the role of myocardial fibrosis detected by late gadolinium enhancement (LGE) on clinical outcome during the mid-term follow up in Chinese ACM patientsMethods:243 consecutive patients with first clinical diagnosis of ACM from June 2008 to December 2011 were examined with CMR and 181 patients met the enrolment criteria in the final cohort. Patients were classified into Group LGE(+) and Group LGE(-) according to the presence of LGE. Differences between groups were compared and cardiac adverse events were recorded. The end point was defined as a composite of hospitalisation for decompensated congestive heart failure, appropriate implantable cardioverter-defibrillator (ICD) discharge or cardiac resynchronization therapy defibrillator (CRT-D), cardiac death and heart transplantation. Survival curves were conducted by the Kaplan-Meier method and compared by the log-rank test. Multivariate Cox proportional hazards regression analysis was performed to calculate hazard ratios (HRs) and identify the independent predictor of adverse outcome.Results:177 patients (97.8%) were male and mean age was 47.5±9.9 years(age extent from 24 to75). Myocardial fibrosis visualized by LGE was detected in71 patients.54 patients of the LGE (+) group exhibited a midwall enhancement, while other 17 showed a patchy nhancement pattern or diffuse enhancement pattern. There were no statistically significant differences between the two groups in baseline characteristics except higher NYHA functional class (3.1±0.8 vs.2.6±0.9, p<0.001) and lower BMI(24.5±3.7vs.25.9±3.9,p=0.02) in LGE (+) patients. In CMR results, LGE (+) patients showed significantly decreased LVEF(22.1±9.1vs.27.1±12.4,p=0.005)and increased LVEDV(p=0.003),LVESV(p=0.003),LVEDVI (p=0.001)LV ESVI(p=0.001) compared with LGE patients. During the follow-up period, the incidence of cardiac events was significantly higher in patients with LGE than that without LGE (47.9% vs.20.0%,p<0.001). The Kaplan-Meier analysis showed a significantly worse outcome among LGE (+) group than in LGE (-) group (log rank, p<0.001). Cox regression analysis identified the presence of LGE or midwall LGE as independent predictor of cardiac events (p=0.003, HR=2.4 and p=0.03, HR=1.82)when entered into multivariable model. The cut-off value of extent of LGE as 4.05% with area under ROC curve 0.78 had a sensitivity of 76.5% and specificity of 70.5% to predict worse outcome.Conclusions:CMR is a helpful tool for the exclusion diagnosis of ACM. The presence and extent of LGE was associated with worse outcome in Chinese ACM patients and LGE was independent prognostic predictor of adverse cardiac events.