Long term prognostic importance of late gadolinium enhancement in first-presentation non-ischaemic dilated cardiomyopathy

Karthigesh Sree Raman, Gaetano Nucifora, Darryl P. Leong, Christian Marx, Ranjit Shah, Richard J. Woodman, Payman Molaee, Masoumeh Gh Shirazi, Andrew D. McGavigan, Carmine G. De Pasquale, Joseph Selvanayagam

Research output: Contribution to journalArticle

Abstract

Background: Presence of myocardial fibrosis in well-established non-ischaemic dilated cardiomyopathy (NIDCM) is associated with adverse clinical outcomes. However, the impact of myocardial fibrosis at first presentation in NIDCM, and its long-term association with left ventricular (LV) dysfunction, heart failure (HF) and ventricular arrhythmia (VA) remains unclear. We investigated whether the presence of myocardial fibrosis quantified by late gadolinium enhancement cardiovascular magnetic resonance (LGE-CMR) at presentation, is independently associated with long-term major adverse cardiovascular events (MACE) in patients with first presentation NIDCM. Methods: Consecutive patients with a first diagnosis of NIDCM were recruited. Patients underwent LGE-CMR at baseline. Replacement myocardial fibrosis by LGE-CMR was quantified by experienced observers blinded to patient outcome. MACE was defined as a composite end-point including cardiac death, HF rehospitalisation and the occurrence of sustained VA. Results: Fifty-one patients with first presentation NIDCM were included, of which 49 (96%) had follow up and outcome data. Median follow up was 8.2 years. Both the LGE positive and LGE negative groups had similar clinical characteristics at follow up. In univariate Cox regression analysis, positive LGE was associated with MACE (HR:3.44; 95% CI:1.89 to 6.24, p-value < 0.001) and HF rehospitalisation (HR:2.89; 95% CI:1.42 to 5.85, p-value = 0.003). In multivariate Cox regression, positive LGE-CMR was independently associated with MACE (HR:3.53; 95% CI:1.51 to 8.27, p-value = 0.004) and HF rehospitalisation (HR:3.07; 95% CI:1.24 to 7.59, p-value = 0.015). Conclusions: The presence of myocardial fibrosis in first presentation NIDCM is independently associated with an increased risk of HF rehospitalisation, at long term follow-up.

LanguageEnglish
Pages124-129
Number of pages6
JournalInternational Journal of Cardiology
Volume280
DOIs
Publication statusPublished - 1 Apr 2019

Keywords

  • Cardiomyopathy
  • Heart failure
  • Magnetic Resonance Imaging (MRI)
  • Prognosis

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Sree Raman, Karthigesh ; Nucifora, Gaetano ; Leong, Darryl P. ; Marx, Christian ; Shah, Ranjit ; Woodman, Richard J. ; Molaee, Payman ; Shirazi, Masoumeh Gh ; McGavigan, Andrew D. ; De Pasquale, Carmine G. ; Selvanayagam, Joseph. / Long term prognostic importance of late gadolinium enhancement in first-presentation non-ischaemic dilated cardiomyopathy. In: International Journal of Cardiology. 2019 ; Vol. 280. pp. 124-129.
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title = "Long term prognostic importance of late gadolinium enhancement in first-presentation non-ischaemic dilated cardiomyopathy",
abstract = "Background: Presence of myocardial fibrosis in well-established non-ischaemic dilated cardiomyopathy (NIDCM) is associated with adverse clinical outcomes. However, the impact of myocardial fibrosis at first presentation in NIDCM, and its long-term association with left ventricular (LV) dysfunction, heart failure (HF) and ventricular arrhythmia (VA) remains unclear. We investigated whether the presence of myocardial fibrosis quantified by late gadolinium enhancement cardiovascular magnetic resonance (LGE-CMR) at presentation, is independently associated with long-term major adverse cardiovascular events (MACE) in patients with first presentation NIDCM. Methods: Consecutive patients with a first diagnosis of NIDCM were recruited. Patients underwent LGE-CMR at baseline. Replacement myocardial fibrosis by LGE-CMR was quantified by experienced observers blinded to patient outcome. MACE was defined as a composite end-point including cardiac death, HF rehospitalisation and the occurrence of sustained VA. Results: Fifty-one patients with first presentation NIDCM were included, of which 49 (96{\%}) had follow up and outcome data. Median follow up was 8.2 years. Both the LGE positive and LGE negative groups had similar clinical characteristics at follow up. In univariate Cox regression analysis, positive LGE was associated with MACE (HR:3.44; 95{\%} CI:1.89 to 6.24, p-value < 0.001) and HF rehospitalisation (HR:2.89; 95{\%} CI:1.42 to 5.85, p-value = 0.003). In multivariate Cox regression, positive LGE-CMR was independently associated with MACE (HR:3.53; 95{\%} CI:1.51 to 8.27, p-value = 0.004) and HF rehospitalisation (HR:3.07; 95{\%} CI:1.24 to 7.59, p-value = 0.015). Conclusions: The presence of myocardial fibrosis in first presentation NIDCM is independently associated with an increased risk of HF rehospitalisation, at long term follow-up.",
keywords = "Cardiomyopathy, Heart failure, Magnetic Resonance Imaging (MRI), Prognosis",
author = "{Sree Raman}, Karthigesh and Gaetano Nucifora and Leong, {Darryl P.} and Christian Marx and Ranjit Shah and Woodman, {Richard J.} and Payman Molaee and Shirazi, {Masoumeh Gh} and McGavigan, {Andrew D.} and {De Pasquale}, {Carmine G.} and Joseph Selvanayagam",
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Sree Raman, K, Nucifora, G, Leong, DP, Marx, C, Shah, R, Woodman, RJ, Molaee, P, Shirazi, MG, McGavigan, AD, De Pasquale, CG & Selvanayagam, J 2019, 'Long term prognostic importance of late gadolinium enhancement in first-presentation non-ischaemic dilated cardiomyopathy', International Journal of Cardiology, vol. 280, pp. 124-129. https://doi.org/10.1016/j.ijcard.2019.01.018

Long term prognostic importance of late gadolinium enhancement in first-presentation non-ischaemic dilated cardiomyopathy. / Sree Raman, Karthigesh; Nucifora, Gaetano; Leong, Darryl P.; Marx, Christian; Shah, Ranjit; Woodman, Richard J.; Molaee, Payman; Shirazi, Masoumeh Gh; McGavigan, Andrew D.; De Pasquale, Carmine G.; Selvanayagam, Joseph.

In: International Journal of Cardiology, Vol. 280, 01.04.2019, p. 124-129.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Long term prognostic importance of late gadolinium enhancement in first-presentation non-ischaemic dilated cardiomyopathy

AU - Sree Raman, Karthigesh

AU - Nucifora, Gaetano

AU - Leong, Darryl P.

AU - Marx, Christian

AU - Shah, Ranjit

AU - Woodman, Richard J.

AU - Molaee, Payman

AU - Shirazi, Masoumeh Gh

AU - McGavigan, Andrew D.

AU - De Pasquale, Carmine G.

AU - Selvanayagam, Joseph

PY - 2019/4/1

Y1 - 2019/4/1

N2 - Background: Presence of myocardial fibrosis in well-established non-ischaemic dilated cardiomyopathy (NIDCM) is associated with adverse clinical outcomes. However, the impact of myocardial fibrosis at first presentation in NIDCM, and its long-term association with left ventricular (LV) dysfunction, heart failure (HF) and ventricular arrhythmia (VA) remains unclear. We investigated whether the presence of myocardial fibrosis quantified by late gadolinium enhancement cardiovascular magnetic resonance (LGE-CMR) at presentation, is independently associated with long-term major adverse cardiovascular events (MACE) in patients with first presentation NIDCM. Methods: Consecutive patients with a first diagnosis of NIDCM were recruited. Patients underwent LGE-CMR at baseline. Replacement myocardial fibrosis by LGE-CMR was quantified by experienced observers blinded to patient outcome. MACE was defined as a composite end-point including cardiac death, HF rehospitalisation and the occurrence of sustained VA. Results: Fifty-one patients with first presentation NIDCM were included, of which 49 (96%) had follow up and outcome data. Median follow up was 8.2 years. Both the LGE positive and LGE negative groups had similar clinical characteristics at follow up. In univariate Cox regression analysis, positive LGE was associated with MACE (HR:3.44; 95% CI:1.89 to 6.24, p-value < 0.001) and HF rehospitalisation (HR:2.89; 95% CI:1.42 to 5.85, p-value = 0.003). In multivariate Cox regression, positive LGE-CMR was independently associated with MACE (HR:3.53; 95% CI:1.51 to 8.27, p-value = 0.004) and HF rehospitalisation (HR:3.07; 95% CI:1.24 to 7.59, p-value = 0.015). Conclusions: The presence of myocardial fibrosis in first presentation NIDCM is independently associated with an increased risk of HF rehospitalisation, at long term follow-up.

AB - Background: Presence of myocardial fibrosis in well-established non-ischaemic dilated cardiomyopathy (NIDCM) is associated with adverse clinical outcomes. However, the impact of myocardial fibrosis at first presentation in NIDCM, and its long-term association with left ventricular (LV) dysfunction, heart failure (HF) and ventricular arrhythmia (VA) remains unclear. We investigated whether the presence of myocardial fibrosis quantified by late gadolinium enhancement cardiovascular magnetic resonance (LGE-CMR) at presentation, is independently associated with long-term major adverse cardiovascular events (MACE) in patients with first presentation NIDCM. Methods: Consecutive patients with a first diagnosis of NIDCM were recruited. Patients underwent LGE-CMR at baseline. Replacement myocardial fibrosis by LGE-CMR was quantified by experienced observers blinded to patient outcome. MACE was defined as a composite end-point including cardiac death, HF rehospitalisation and the occurrence of sustained VA. Results: Fifty-one patients with first presentation NIDCM were included, of which 49 (96%) had follow up and outcome data. Median follow up was 8.2 years. Both the LGE positive and LGE negative groups had similar clinical characteristics at follow up. In univariate Cox regression analysis, positive LGE was associated with MACE (HR:3.44; 95% CI:1.89 to 6.24, p-value < 0.001) and HF rehospitalisation (HR:2.89; 95% CI:1.42 to 5.85, p-value = 0.003). In multivariate Cox regression, positive LGE-CMR was independently associated with MACE (HR:3.53; 95% CI:1.51 to 8.27, p-value = 0.004) and HF rehospitalisation (HR:3.07; 95% CI:1.24 to 7.59, p-value = 0.015). Conclusions: The presence of myocardial fibrosis in first presentation NIDCM is independently associated with an increased risk of HF rehospitalisation, at long term follow-up.

KW - Cardiomyopathy

KW - Heart failure

KW - Magnetic Resonance Imaging (MRI)

KW - Prognosis

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U2 - 10.1016/j.ijcard.2019.01.018

DO - 10.1016/j.ijcard.2019.01.018

M3 - Article

VL - 280

SP - 124

EP - 129

JO - International Journal of Cardiology

T2 - International Journal of Cardiology

JF - International Journal of Cardiology

SN - 0167-5273

ER -