PMID- 25160650
OWN - NLM
STAT- MEDLINE
DCOM- 20150120
LR  - 20211021
IS  - 1471-2261 (Electronic)
IS  - 1471-2261 (Linking)
VI  - 14
DP  - 2014 Aug 27
TI  - Quantifying late gadolinium enhancement on CMR provides additional prognostic 
      information in early risk-stratification of nonischemic cardiomyopathy: a cohort 
      study.
PG  - 110
LID - 10.1186/1471-2261-14-110 [doi]
LID - 110
AB  - BACKGROUND: Suspected nonischemic cardiomyopathy (NICM) is a common clinical 
      setting with highly variable prognosis. Early noninvasive risk-stratification is 
      important for justification of invasive examinations, specific treatment and 
      patient surveillance. We studied the additional prognostic value of late 
      gadolinium enhancement (LGE) and segmental wall motion abnormality (SWMA) extent 
      on cardiovascular magnetic resonance (CMR) compared to traditional risk factors 
      in suspected NICM. METHODS: In this observational cohort study, we enrolled 86 
      consecutive patients referred for CMR due to suspected NICM. Patients with 
      ischemic cardiomyopathy were excluded. CMR images were analysed for left 
      ventricular LGE and SWMA extents and patients were followed-up for major adverse 
      cardiac events (MACE), including cardiovascular death, aborted sudden death and 
      cardiac transplantation. RESULTS: Of 86 patients (median age: 53 years, 45% 
      female), mainly presenting with ventricular arrhythmias (40%) and congestive 
      heart failure (44%), 76% were finally diagnosed with NICM, 17% with left 
      ventricle hypertrophy and 7% with idiopathic arrhythmia. On CMR, 61 patients 
      (71%) had LGE and 56 (65%) SWMA. During median follow-up of 835 days, 15 patients 
      (17%) reached MACE. In univariant analysis, LGE volume (hazard ratio [HR] 1.028 
      per 1% increase in LGE, p < 0.001), left ventricular ejection fraction (LVEF) (HR 
      0.959, p = 0.009) and SWMA score (HR 1.067, p = 0.012) had strongest associations 
      with MACE. In multivariate analysis, the best overall model for event prediction 
      included LGE volume (HR 1.027, p = 0.003), sustained ventricular tachycardia (HR 
      4.7, p = 0.011) and LVEF (HR 0.962, p = 0.034). Among patients with LGE, there 
      was an event rate of 26% (14 of 61) versus 4% (1 of 25) in patients without LGE 
      (p = 0.041, Log-rank). The highest event rate was observed in patients with LGE 
      volume of >/= 17%. Patients without SWMA did not experience MACE (p = 0.002, 
      Log-rank), giving additional information in the subgroup of patients with 
      preserved LVEF (>/= 50%). CONCLUSIONS: In suspected NICM, presenting with 
      ventricular arrhythmias or heart failure, LGE extent gives additional prognostic 
      information compared to traditional risk factors, while the absence of SWMA may 
      give prognostic information beyond normal LVEF. Even though the final diagnosis 
      is uncertain in NICM, extensive amount of LGE should be considered as a sign of 
      poor prognosis.
FAU - Poyhonen, Pauli
AU  - Poyhonen P
AD  - Heart and Lung Center, Division of Cardiology, Helsinki University Central 
      Hospital, Po BOX 340, 00029 HUCH Helsinki, Finland. pauli.poyhonen@helsinki.fi.
FAU - Kivisto, Sari
AU  - Kivisto S
FAU - Holmstrom, Miia
AU  - Holmstrom M
FAU - Hanninen, Helena
AU  - Hanninen H
LA  - eng
PT  - Journal Article
PT  - Observational Study
PT  - Research Support, Non-U.S. Gov't
DEP - 20140827
PL  - England
TA  - BMC Cardiovasc Disord
JT  - BMC cardiovascular disorders
JID - 100968539
RN  - 0 (Contrast Media)
RN  - 0 (Organometallic Compounds)
RN  - 6HG8UB2MUY (Meglumine)
RN  - L0ND3981AG (gadoterate meglumine)
SB  - IM
MH  - Adult
MH  - Arrhythmias, Cardiac/etiology
MH  - Cardiomyopathies/*diagnosis/etiology/pathology/physiopathology
MH  - *Contrast Media
MH  - Diagnosis, Differential
MH  - Female
MH  - Heart Failure/etiology
MH  - Heart Ventricles/*pathology/physiopathology
MH  - Humans
MH  - *Magnetic Resonance Imaging, Cine
MH  - Male
MH  - *Meglumine
MH  - Middle Aged
MH  - *Organometallic Compounds
MH  - Predictive Value of Tests
MH  - Prognosis
MH  - Retrospective Studies
MH  - Risk Factors
MH  - Stroke Volume
MH  - Ventricular Function, Left
PMC - PMC4153898
EDAT- 2014/08/28 06:00
MHDA- 2015/01/21 06:00
PMCR- 2014/08/27
CRDT- 2014/08/28 06:00
PHST- 2014/03/28 00:00 [received]
PHST- 2014/08/19 00:00 [accepted]
PHST- 2014/08/28 06:00 [entrez]
PHST- 2014/08/28 06:00 [pubmed]
PHST- 2015/01/21 06:00 [medline]
PHST- 2014/08/27 00:00 [pmc-release]
AID - 1471-2261-14-110 [pii]
AID - 752 [pii]
AID - 10.1186/1471-2261-14-110 [doi]
PST - epublish
SO  - BMC Cardiovasc Disord. 2014 Aug 27;14:110. doi: 10.1186/1471-2261-14-110.