PMID- 23324403 OWN - NLM STAT- MEDLINE DCOM- 20130801 LR - 20240117 IS - 1532-429X (Electronic) IS - 1097-6647 (Print) IS - 1097-6647 (Linking) VI - 15 IP - 1 DP - 2013 Jan 16 TI - Effectiveness of late gadolinium enhancement to improve outcomes prediction in patients referred for cardiovascular magnetic resonance after echocardiography. PG - 6 LID - 10.1186/1532-429X-15-6 [doi] AB - BACKGROUND: Echocardiography (echo) is a first line test to assess cardiac structure and function. It is not known if cardiovascular magnetic resonance (CMR) with late gadolinium enhancement (LGE) ordered during routine clinical practice in selected patients can add additional prognostic information after routine echo. We assessed whether CMR improves outcomes prediction after contemporaneous echo, which may have implications for efforts to optimize processes of care, assess effectiveness, and allocate limited health care resources. METHODS AND RESULTS: We prospectively enrolled 1044 consecutive patients referred for CMR. There were 38 deaths and 3 cardiac transplants over a median follow-up of 1.0 years (IQR 0.4-1.5). We first reproduced previous survival curve strata (presence of LGE and ejection fraction (EF) < 50%) for transplant free survival, to support generalizability of any findings. Then, in a subset (n = 444) with contemporaneous echo (median 3 days apart, IQR 1-9), EF by echo (assessed visually) or CMR were modestly correlated (R(2) = 0.66, p < 0.001), and 30 deaths and 3 transplants occurred over a median follow-up of 0.83 years (IQR 0.29-1.40). CMR EF predicted mortality better than echo EF in univariable Cox models (Integrated Discrimination Improvement (IDI) 0.018, 95% CI 0.008-0.034; Net Reclassification Improvement (NRI) 0.51, 95% CI 0.11-0.85). Finally, LGE further improved prediction beyond EF as determined by hazard ratios, NRI, and IDI in all Cox models predicting mortality or transplant free survival, adjusting for age, gender, wall motion, and EF. CONCLUSIONS: Among those referred for CMR after echocardiography, CMR with LGE further improves risk stratification of individuals at risk for death or death/cardiac transplant. FAU - Wong, Timothy C AU - Wong TC AD - Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA. FAU - Piehler, Kayla AU - Piehler K FAU - Puntil, Kathy S AU - Puntil KS FAU - Moguillansky, Diego AU - Moguillansky D FAU - Meier, Christopher G AU - Meier CG FAU - Lacomis, Joan M AU - Lacomis JM FAU - Kellman, Peter AU - Kellman P FAU - Cook, Stephen C AU - Cook SC FAU - Schwartzman, David S AU - Schwartzman DS FAU - Simon, Marc A AU - Simon MA FAU - Mulukutla, Suresh R AU - Mulukutla SR FAU - Schelbert, Erik B AU - Schelbert EB LA - eng GR - UL1 TR000005/TR/NCATS NIH HHS/United States GR - UL1 RR024153/RR/NCRR NIH HHS/United States GR - K12 HS19461-01/HS/AHRQ HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural PT - Research Support, Non-U.S. Gov't PT - Research Support, U.S. Gov't, P.H.S. DEP - 20130116 PL - England TA - J Cardiovasc Magn Reson JT - Journal of cardiovascular magnetic resonance : official journal of the Society for Cardiovascular Magnetic Resonance JID - 9815616 RN - 0 (Contrast Media) RN - 0 (Heterocyclic Compounds) RN - 0 (Organometallic Compounds) RN - 0199MV609F (gadoteridol) RN - AU0V1LM3JT (Gadolinium) SB - IM MH - Adult MH - Aged MH - Chi-Square Distribution MH - *Contrast Media MH - Disease-Free Survival MH - *Echocardiography MH - Female MH - Gadolinium MH - Heart Diseases/*diagnosis/diagnostic imaging/mortality/pathology/physiopathology/therapy MH - Heart Transplantation MH - *Heterocyclic Compounds MH - Humans MH - Kaplan-Meier Estimate MH - Linear Models MH - *Magnetic Resonance Imaging, Cine MH - Male MH - Middle Aged MH - Myocardium/pathology MH - *Organometallic Compounds MH - Predictive Value of Tests MH - Prognosis MH - Proportional Hazards Models MH - Prospective Studies MH - Risk Factors MH - Stroke Volume MH - Time Factors MH - Ventricular Function, Left PMC - PMC3599652 EDAT- 2013/01/18 06:00 MHDA- 2013/08/02 06:00 PMCR- 2013/01/16 CRDT- 2013/01/18 06:00 PHST- 2012/07/16 00:00 [received] PHST- 2012/12/17 00:00 [accepted] PHST- 2013/01/18 06:00 [entrez] PHST- 2013/01/18 06:00 [pubmed] PHST- 2013/08/02 06:00 [medline] PHST- 2013/01/16 00:00 [pmc-release] AID - S1097-6647(23)00722-6 [pii] AID - 1532-429X-15-6 [pii] AID - 10.1186/1532-429X-15-6 [doi] PST - epublish SO - J Cardiovasc Magn Reson. 2013 Jan 16;15(1):6. doi: 10.1186/1532-429X-15-6.