PMID- 24647118 OWN - NLM STAT- MEDLINE DCOM- 20140917 LR - 20140521 IS - 1941-3297 (Electronic) IS - 1941-3289 (Linking) VI - 7 IP - 3 DP - 2014 May TI - Incremental prognostic value of myocardial fibrosis in patients with non-ischemic cardiomyopathy without congestive heart failure. PG - 448-56 LID - 10.1161/CIRCHEARTFAILURE.113.000996 [doi] AB - BACKGROUND: We conducted a prospective longitudinal study to investigate the yet unknown clinical significance of myocardial fibrosis in patients with non-ischemic cardiomyopathy without history of congestive heart failure (CHF). METHODS AND RESULTS: At 3 tertiary referral centers, 228 patients with non-ischemic cardiomyopathy without history of CHF were studied with cardiovascular magnetic resonance for late gadolinium enhancement (LGE) detection and quantification and prospectively followed up for a median of 23 months. The end point was a composite of cardiac death, onset of CHF, and aborted sudden cardiac death. LGE was detected in 61 (27%) patients. Thirty-one of 61 (51%) patients with LGE reached combined end point when compared with 18 of 167 (11%) patients without LGE (hazard ratio, 5.10 [2.78-9.36]; P<0.001). Patients with LGE had greater risk of developing CHF than patients without LGE (hazard ratio, 5.23 [2.61-10.50]; P<0.001) and higher rate of aborted sudden cardiac death (hazard ratio, 8.31 [1.66-41.55]; P=0.010). Multivariate analysis showed that LGE was associated with high likelihood of composite end point independent of other prognostic determinants, including age; duration of cardiomyopathy; and left ventricular volumes, mass, and ejection fraction (hazard ratio, 4.02 [2.08-7.76]; P<0.001). Improvement chi(2) analysis disclosed that LGE addition to models, including clinical data alone or in combination with parameters of left ventricular remodeling and function, yielded an improvement in outcome prediction (P<0.001). Addition of LGE to age and left ventricular ejection fraction improved risk stratification for composite end point (net reclassification improvement, 29.6%) and onset of CHF (net reclassification improvement, 25.4%; both P<0.001). CONCLUSIONS: In patients with non-ischemic cardiomyopathy without history of CHF, myocardial fibrosis is a strong and independent predictor of outcome, providing incremental prognostic information and improvement in risk stratification beyond clinical data and degree of left ventricular dysfunction. CI - (c) 2014 American Heart Association, Inc. FAU - Masci, Pier Giorgio AU - Masci PG AD - From the Cardiovascular Magnetic Resonance Department (P.G.M., M.L.), and the Cardiology Department (A.B., A.D.T., M.E.), Fondazione CNR/Regione Toscana "G. Monasterio," Pisa, Italy; Departments of Radiology (C.D., R.S., J.B.) and Cardiology (W.D.), Gasthuisberg University Hospital, Leuven, Belgium; Centro Cardiologico Monzino, Milano, Italy (E.B., G.P., D.A., P.G., S.M.); Cardiovascular Section, Department of Clinical Sciences and Community Health, University of Milan, Milano, Italy (D.A.); and Management Institute (V.L.) and Medical Sciences (A.D.T.), Scuola Superiore Sant'Anna, Pisa, Italy (A.D.T., V.L.). masci@ftgm.it pgmasci@tiscali.it. FAU - Doulaptsis, Constantinos AU - Doulaptsis C AD - From the Cardiovascular Magnetic Resonance Department (P.G.M., M.L.), and the Cardiology Department (A.B., A.D.T., M.E.), Fondazione CNR/Regione Toscana "G. Monasterio," Pisa, Italy; Departments of Radiology (C.D., R.S., J.B.) and Cardiology (W.D.), Gasthuisberg University Hospital, Leuven, Belgium; Centro Cardiologico Monzino, Milano, Italy (E.B., G.P., D.A., P.G., S.M.); Cardiovascular Section, Department of Clinical Sciences and Community Health, University of Milan, Milano, Italy (D.A.); and Management Institute (V.L.) and Medical Sciences (A.D.T.), Scuola Superiore Sant'Anna, Pisa, Italy (A.D.T., V.L.). FAU - Bertella, Erika AU - Bertella E AD - From the Cardiovascular Magnetic Resonance Department (P.G.M., M.L.), and the Cardiology Department (A.B., A.D.T., M.E.), Fondazione CNR/Regione Toscana "G. Monasterio," Pisa, Italy; Departments of Radiology (C.D., R.S., J.B.) and Cardiology (W.D.), Gasthuisberg University Hospital, Leuven, Belgium; Centro Cardiologico Monzino, Milano, Italy (E.B., G.P., D.A., P.G., S.M.); Cardiovascular Section, Department of Clinical Sciences and Community Health, University of Milan, Milano, Italy (D.A.); and Management Institute (V.L.) and Medical Sciences (A.D.T.), Scuola Superiore Sant'Anna, Pisa, Italy (A.D.T., V.L.). FAU - Del Torto, Alberico AU - Del Torto A AD - From the Cardiovascular Magnetic Resonance Department (P.G.M., M.L.), and the Cardiology Department (A.B., A.D.T., M.E.), Fondazione CNR/Regione Toscana "G. Monasterio," Pisa, Italy; Departments of Radiology (C.D., R.S., J.B.) and Cardiology (W.D.), Gasthuisberg University Hospital, Leuven, Belgium; Centro Cardiologico Monzino, Milano, Italy (E.B., G.P., D.A., P.G., S.M.); Cardiovascular Section, Department of Clinical Sciences and Community Health, University of Milan, Milano, Italy (D.A.); and Management Institute (V.L.) and Medical Sciences (A.D.T.), Scuola Superiore Sant'Anna, Pisa, Italy (A.D.T., V.L.). FAU - Symons, Rolf AU - Symons R AD - From the Cardiovascular Magnetic Resonance Department (P.G.M., M.L.), and the Cardiology Department (A.B., A.D.T., M.E.), Fondazione CNR/Regione Toscana "G. Monasterio," Pisa, Italy; Departments of Radiology (C.D., R.S., J.B.) and Cardiology (W.D.), Gasthuisberg University Hospital, Leuven, Belgium; Centro Cardiologico Monzino, Milano, Italy (E.B., G.P., D.A., P.G., S.M.); Cardiovascular Section, Department of Clinical Sciences and Community Health, University of Milan, Milano, Italy (D.A.); and Management Institute (V.L.) and Medical Sciences (A.D.T.), Scuola Superiore Sant'Anna, Pisa, Italy (A.D.T., V.L.). FAU - Pontone, Gianluca AU - Pontone G AD - From the Cardiovascular Magnetic Resonance Department (P.G.M., M.L.), and the Cardiology Department (A.B., A.D.T., M.E.), Fondazione CNR/Regione Toscana "G. Monasterio," Pisa, Italy; Departments of Radiology (C.D., R.S., J.B.) and Cardiology (W.D.), Gasthuisberg University Hospital, Leuven, Belgium; Centro Cardiologico Monzino, Milano, Italy (E.B., G.P., D.A., P.G., S.M.); Cardiovascular Section, Department of Clinical Sciences and Community Health, University of Milan, Milano, Italy (D.A.); and Management Institute (V.L.) and Medical Sciences (A.D.T.), Scuola Superiore Sant'Anna, Pisa, Italy (A.D.T., V.L.). FAU - Barison, Andrea AU - Barison A AD - From the Cardiovascular Magnetic Resonance Department (P.G.M., M.L.), and the Cardiology Department (A.B., A.D.T., M.E.), Fondazione CNR/Regione Toscana "G. Monasterio," Pisa, Italy; Departments of Radiology (C.D., R.S., J.B.) and Cardiology (W.D.), Gasthuisberg University Hospital, Leuven, Belgium; Centro Cardiologico Monzino, Milano, Italy (E.B., G.P., D.A., P.G., S.M.); Cardiovascular Section, Department of Clinical Sciences and Community Health, University of Milan, Milano, Italy (D.A.); and Management Institute (V.L.) and Medical Sciences (A.D.T.), Scuola Superiore Sant'Anna, Pisa, Italy (A.D.T., V.L.). FAU - Droogne, Walter AU - Droogne W AD - From the Cardiovascular Magnetic Resonance Department (P.G.M., M.L.), and the Cardiology Department (A.B., A.D.T., M.E.), Fondazione CNR/Regione Toscana "G. Monasterio," Pisa, Italy; Departments of Radiology (C.D., R.S., J.B.) and Cardiology (W.D.), Gasthuisberg University Hospital, Leuven, Belgium; Centro Cardiologico Monzino, Milano, Italy (E.B., G.P., D.A., P.G., S.M.); Cardiovascular Section, Department of Clinical Sciences and Community Health, University of Milan, Milano, Italy (D.A.); and Management Institute (V.L.) and Medical Sciences (A.D.T.), Scuola Superiore Sant'Anna, Pisa, Italy (A.D.T., V.L.). FAU - Andreini, Daniele AU - Andreini D AD - From the Cardiovascular Magnetic Resonance Department (P.G.M., M.L.), and the Cardiology Department (A.B., A.D.T., M.E.), Fondazione CNR/Regione Toscana "G. Monasterio," Pisa, Italy; Departments of Radiology (C.D., R.S., J.B.) and Cardiology (W.D.), Gasthuisberg University Hospital, Leuven, Belgium; Centro Cardiologico Monzino, Milano, Italy (E.B., G.P., D.A., P.G., S.M.); Cardiovascular Section, Department of Clinical Sciences and Community Health, University of Milan, Milano, Italy (D.A.); and Management Institute (V.L.) and Medical Sciences (A.D.T.), Scuola Superiore Sant'Anna, Pisa, Italy (A.D.T., V.L.). FAU - Lorenzoni, Valentina AU - Lorenzoni V AD - From the Cardiovascular Magnetic Resonance Department (P.G.M., M.L.), and the Cardiology Department (A.B., A.D.T., M.E.), Fondazione CNR/Regione Toscana "G. Monasterio," Pisa, Italy; Departments of Radiology (C.D., R.S., J.B.) and Cardiology (W.D.), Gasthuisberg University Hospital, Leuven, Belgium; Centro Cardiologico Monzino, Milano, Italy (E.B., G.P., D.A., P.G., S.M.); Cardiovascular Section, Department of Clinical Sciences and Community Health, University of Milan, Milano, Italy (D.A.); and Management Institute (V.L.) and Medical Sciences (A.D.T.), Scuola Superiore Sant'Anna, Pisa, Italy (A.D.T., V.L.). FAU - Gripari, Paola AU - Gripari P AD - From the Cardiovascular Magnetic Resonance Department (P.G.M., M.L.), and the Cardiology Department (A.B., A.D.T., M.E.), Fondazione CNR/Regione Toscana "G. Monasterio," Pisa, Italy; Departments of Radiology (C.D., R.S., J.B.) and Cardiology (W.D.), Gasthuisberg University Hospital, Leuven, Belgium; Centro Cardiologico Monzino, Milano, Italy (E.B., G.P., D.A., P.G., S.M.); Cardiovascular Section, Department of Clinical Sciences and Community Health, University of Milan, Milano, Italy (D.A.); and Management Institute (V.L.) and Medical Sciences (A.D.T.), Scuola Superiore Sant'Anna, Pisa, Italy (A.D.T., V.L.). FAU - Mushtaq, Saima AU - Mushtaq S AD - From the Cardiovascular Magnetic Resonance Department (P.G.M., M.L.), and the Cardiology Department (A.B., A.D.T., M.E.), Fondazione CNR/Regione Toscana "G. Monasterio," Pisa, Italy; Departments of Radiology (C.D., R.S., J.B.) and Cardiology (W.D.), Gasthuisberg University Hospital, Leuven, Belgium; Centro Cardiologico Monzino, Milano, Italy (E.B., G.P., D.A., P.G., S.M.); Cardiovascular Section, Department of Clinical Sciences and Community Health, University of Milan, Milano, Italy (D.A.); and Management Institute (V.L.) and Medical Sciences (A.D.T.), Scuola Superiore Sant'Anna, Pisa, Italy (A.D.T., V.L.). FAU - Emdin, Michele AU - Emdin M AD - From the Cardiovascular Magnetic Resonance Department (P.G.M., M.L.), and the Cardiology Department (A.B., A.D.T., M.E.), Fondazione CNR/Regione Toscana "G. Monasterio," Pisa, Italy; Departments of Radiology (C.D., R.S., J.B.) and Cardiology (W.D.), Gasthuisberg University Hospital, Leuven, Belgium; Centro Cardiologico Monzino, Milano, Italy (E.B., G.P., D.A., P.G., S.M.); Cardiovascular Section, Department of Clinical Sciences and Community Health, University of Milan, Milano, Italy (D.A.); and Management Institute (V.L.) and Medical Sciences (A.D.T.), Scuola Superiore Sant'Anna, Pisa, Italy (A.D.T., V.L.). FAU - Bogaert, Jan AU - Bogaert J AD - From the Cardiovascular Magnetic Resonance Department (P.G.M., M.L.), and the Cardiology Department (A.B., A.D.T., M.E.), Fondazione CNR/Regione Toscana "G. Monasterio," Pisa, Italy; Departments of Radiology (C.D., R.S., J.B.) and Cardiology (W.D.), Gasthuisberg University Hospital, Leuven, Belgium; Centro Cardiologico Monzino, Milano, Italy (E.B., G.P., D.A., P.G., S.M.); Cardiovascular Section, Department of Clinical Sciences and Community Health, University of Milan, Milano, Italy (D.A.); and Management Institute (V.L.) and Medical Sciences (A.D.T.), Scuola Superiore Sant'Anna, Pisa, Italy (A.D.T., V.L.). FAU - Lombardi, Massimo AU - Lombardi M AD - From the Cardiovascular Magnetic Resonance Department (P.G.M., M.L.), and the Cardiology Department (A.B., A.D.T., M.E.), Fondazione CNR/Regione Toscana "G. Monasterio," Pisa, Italy; Departments of Radiology (C.D., R.S., J.B.) and Cardiology (W.D.), Gasthuisberg University Hospital, Leuven, Belgium; Centro Cardiologico Monzino, Milano, Italy (E.B., G.P., D.A., P.G., S.M.); Cardiovascular Section, Department of Clinical Sciences and Community Health, University of Milan, Milano, Italy (D.A.); and Management Institute (V.L.) and Medical Sciences (A.D.T.), Scuola Superiore Sant'Anna, Pisa, Italy (A.D.T., V.L.). LA - eng PT - Journal Article PT - Multicenter Study DEP - 20140319 PL - United States TA - Circ Heart Fail JT - Circulation. Heart failure JID - 101479941 SB - IM CIN - Circ Heart Fail. 2014 May;7(3):391-3. PMID: 24847127 MH - Adult MH - Aged MH - Cardiomyopathies/*diagnosis/mortality/*pathology MH - Cohort Studies MH - Female MH - Fibrosis MH - Follow-Up Studies MH - *Heart Failure MH - Humans MH - Kaplan-Meier Estimate MH - Longitudinal Studies MH - Magnetic Resonance Imaging MH - Male MH - Middle Aged MH - Multivariate Analysis MH - Myocardium/*pathology MH - Predictive Value of Tests MH - Prognosis MH - Prospective Studies OTO - NOTNLM OT - cardiomyopathies OT - fibrosis OT - magnetic resonance imaging EDAT- 2014/03/22 06:00 MHDA- 2014/09/18 06:00 CRDT- 2014/03/21 06:00 PHST- 2014/03/21 06:00 [entrez] PHST- 2014/03/22 06:00 [pubmed] PHST- 2014/09/18 06:00 [medline] AID - CIRCHEARTFAILURE.113.000996 [pii] AID - 10.1161/CIRCHEARTFAILURE.113.000996 [doi] PST - ppublish SO - Circ Heart Fail. 2014 May;7(3):448-56. doi: 10.1161/CIRCHEARTFAILURE.113.000996. Epub 2014 Mar 19.