PMID- 27708858 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20210109 IS - 2055-5822 (Print) IS - 2055-5822 (Electronic) IS - 2055-5822 (Linking) VI - 2 IP - 4 DP - 2015 Dec TI - Mid wall fibrosis on CMR with late gadolinium enhancement may predict prognosis for LVAD and transplantation risk in patients with newly diagnosed dilated cardiomyopathy-preliminary observations from a high-volume transplant centre. PG - 150-159 AB - BACKGROUND: Patients with newly diagnosed dilated cardiomyopathy (DCM) and advanced heart failure have a very high morbidity and mortality with an unpredictable clinical course. We investigated the role of cardiovascular magnetic resonance (CMR) imaging using late gadolinium enhancement (LGE) in this cohort of high-risk patients. We hypothesized that LGE has high prognostic value in primary DCM patients referred for possible transplantation/left ventricular assist device (LVAD) consideration. METHODS: Over 49 consecutive months, 61 consecutives DCM patients were referred for standard CMR(1.5T, GE) to interrogate the LV pattern, distribution, and extent of LGE (MultiHance, Princeton, NJ). Inclusion criteria for a primary non-ischaemic DCM and EF <45% were met in 31 patients. DCM patients were categorized into: (i) presence of midwall LV stripe (+Stripe) and (ii) absence of midwall stripe (-Stripe) groups. Primary outcome was defined by the composite of death, need for LV assist device (LVAD), and urgent orthotopic cardiac transplantation (Tx) during a 12-month follow-up period. Kaplan-Meier survival analysis was conducted grouping patients by +Stripe and -Stripe. RESULTS: There were no differences between groups for demographics, blood pressure, labs, baseline LVEF, NYHA class, or invasive haemodynamics. There were 18 patients (58%) with +Stripe. Nine events occurred: seven patients required urgent Tx and/or LVAD implantation and two patients died. The +Stripe categorization strongly predicted the need for LVAD, urgent Tx surgery, and death (log-rank = 9, P = 0.002). All the events occurred in the +Stripe patients with no MACE experienced in the -Stripe group. The -Stripe group experienced marked signs of improvement in LVEF (P = 0.01) at follow-up. LVEDD was predictive of need for LVAD/Tx and death by univariate analysis. Otherwise, no common clinical metric such as LVEF, LVEDV, RVEF, RVEDV, or any invasive haemodynamic parameter predicted MACE. CONCLUSIONS: The presence of +Stripe on CMR is strongly predictive of LVAD, transplant need, and death during a 12-month follow-up period in DCM patients in this proof of concept study. All -Stripe patients survived without experiencing any events. Incorporating CMR imaging into routine clinical practice may have prognostic value in DCM patients; indicating conservative management in low-risk patients while expectantly managing high-risk patients. FAU - Venero, Jose V AU - Venero JV AD - Division of Cardiology Allegheny General Hospital East North Ave Pittsburgh PA USA. FAU - Doyle, Mark AU - Doyle M AD - Gerald McGinnis Cardiovascular Institute East North Ave Pittsburgh PA USA. FAU - Shah, Moneal AU - Shah M AD - Division of CardiologyAllegheny General HospitalEast North AvePittsburghPAUSA; Gerald McGinnis Cardiovascular InstituteEast North AvePittsburghPAUSA. FAU - Rathi, Vikas K AU - Rathi VK AD - Bon Secours Richmond Health System Sherwood Drive Colonial Heights VA 23834 USA. FAU - Yamrozik, June A AU - Yamrozik JA AD - Gerald McGinnis Cardiovascular Institute East North Ave Pittsburgh PA USA. FAU - Williams, Ronald B AU - Williams RB AD - Gerald McGinnis Cardiovascular Institute East North Ave Pittsburgh PA USA. FAU - Vido, Diane A AU - Vido DA AD - Division of Cardiology Allegheny General Hospital East North Ave Pittsburgh PA USA. FAU - Rayarao, Geetha AU - Rayarao G AD - Division of Cardiology Allegheny General Hospital East North Ave Pittsburgh PA USA. FAU - Benza, Raymond AU - Benza R AD - Division of CardiologyAllegheny General HospitalEast North AvePittsburghPAUSA; Gerald McGinnis Cardiovascular InstituteEast North AvePittsburghPAUSA. FAU - Murali, Srinivas AU - Murali S AD - Division of CardiologyAllegheny General HospitalEast North AvePittsburghPAUSA; Gerald McGinnis Cardiovascular InstituteEast North AvePittsburghPAUSA. FAU - Glass, Jerry AU - Glass J AD - Division of Pathology Allegheny General Hospital East North Ave Pittsburgh PA USA. FAU - Olson, Peter AU - Olson P AD - Division of Pathology Allegheny General Hospital East North Ave Pittsburgh PA USA. FAU - Sokos, George AU - Sokos G AD - Division of CardiologyAllegheny General HospitalEast North AvePittsburghPAUSA; Gerald McGinnis Cardiovascular InstituteEast North AvePittsburghPAUSA. FAU - Biederman, Robert W W AU - Biederman RW AD - Division of CardiologyAllegheny General HospitalEast North AvePittsburghPAUSA; Gerald McGinnis Cardiovascular InstituteEast North AvePittsburghPAUSA. LA - eng PT - Journal Article DEP - 20150729 PL - England TA - ESC Heart Fail JT - ESC heart failure JID - 101669191 PMC - PMC5034795 OTO - NOTNLM OT - Cardiac MRI OT - Heart transplantation OT - Midwall fibrosis EDAT- 2016/10/07 06:00 MHDA- 2016/10/07 06:01 PMCR- 2015/07/29 CRDT- 2016/10/07 06:00 PHST- 2015/01/27 00:00 [received] PHST- 2015/04/02 00:00 [revised] PHST- 2015/05/03 00:00 [accepted] PHST- 2016/10/07 06:00 [entrez] PHST- 2016/10/07 06:00 [pubmed] PHST- 2016/10/07 06:01 [medline] PHST- 2015/07/29 00:00 [pmc-release] AID - EHF212041 [pii] AID - 10.1002/ehf2.12041 [doi] PST - ppublish SO - ESC Heart Fail. 2015 Dec;2(4):150-159. doi: 10.1002/ehf2.12041. Epub 2015 Jul 29.