PMID- 27839514 OWN - NLM STAT- MEDLINE DCOM- 20171212 LR - 20240117 IS - 1532-429X (Electronic) IS - 1097-6647 (Print) IS - 1097-6647 (Linking) VI - 18 IP - 1 DP - 2016 Nov 14 TI - Objective criteria for septal fibrosis in non-ischemic dilated cardiomyopathy: validation for the prediction of future cardiovascular events. PG - 82 LID - 82 AB - BACKGROUND: Expert subjective reporting of mid-wall septal fibrosis on late gadolinium enhancement (LGE) images has been shown to predict major cardiovascular outcomes in patients with non-ischemic dilated cardiomyopathy (NIDCM). This study aims to establish objective criteria for non-experts to report clinically relevant septal fibrosis and compare its performance by such readers versus experts for the prediction of cardiovascular events. METHODS: LGE cardiovascular magnetic resonance (CMR) was performed in 118 consecutive patients with NIDCM (mean age 57 +/- 14, 42 % female) and the presence of septal fibrosis scored by expert readers. CMR-naive readers performed signal threshold-based LGE quantification by referencing mean values of remote tissue and applying these to a pre-defined anatomic region to measure septal fibrosis. All patients were followed for the primary composite outcome of cardiac mortality or appropriate implantable cardioverter-defibrillator (ICD) therapy. RESULTS: The mean LVEF was 32 +/- 12 %. At a median follow-up of 1.9 years, 20 patients (17 %) experienced a primary composite outcome. Expert visual scoring identified 55 patients with septal fibrosis. Non-expert septal fibrosis quantification was highly reproducible and identified mean septal fibrosis burden for three measured thresholds as follows; 5SD: 2.9 +/- 3.6 %, 3SD: 6.9 +/- 6.3 %, and 2SD: 11.1 +/- 7.5 % of the left ventricular (LV) mass, respectively. By ROC analysis, optimal thresholds for prediction of the primary outcome were; 5SD: 2.74 % (HR 8.7, p < 0.001), 3SD: 6.63 % (HR 5.7, p = 0.001) and 2SD: 10.15 % (HR 6.1, p = 0.001). By comparison, expert visual scoring provided a HR of 5.3 (p = 0.001). In adjusted analysis, objective quantification by a novice reader (>5SD threshold) was the strongest independent predictor of the primary outcome (HR 8.7) and provided improved risk reclassification beyond LVEF alone (NRI 0.54, 95 % CI 0.16-0.92, p = 0.005). CONCLUSIONS: Novice readers were able to achieve superior risk prediction for future cardiovascular events versus experts using objective criteria for septal fibrosis in patients with NIDCM. Patients with a septal fibrosis burden >2.74 % of the LV mass (>5SD threshold) were at a 9-fold higher risk of cardiac death or appropriate ICD therapy versus those not meeting this criteria. As such, this study validates reproducible criteria applicable to all levels of expertise to identify NIDCM patients at high risk of future cardiovascular events. FAU - Mikami, Yoko AU - Mikami Y AD - Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute of Alberta, University of Calgary, #0700, SSB, Foothills Medical Centre, 1403-29th St. NW, Calgary, AB, T2N2T9, Canada. FAU - Cornhill, Aidan AU - Cornhill A AD - Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute of Alberta, University of Calgary, #0700, SSB, Foothills Medical Centre, 1403-29th St. NW, Calgary, AB, T2N2T9, Canada. FAU - Heydari, Bobak AU - Heydari B AD - Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute of Alberta, University of Calgary, #0700, SSB, Foothills Medical Centre, 1403-29th St. NW, Calgary, AB, T2N2T9, Canada. AD - Department of Cardiac Sciences, Libin Cardiovascular Institute, University of Calgary, Calgary, Canada. AD - Department of Diagnostic Imaging, University of Calgary, Calgary, Canada. FAU - Joncas, Sebastien X AU - Joncas SX AD - Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute of Alberta, University of Calgary, #0700, SSB, Foothills Medical Centre, 1403-29th St. NW, Calgary, AB, T2N2T9, Canada. FAU - Almehmadi, Fahad AU - Almehmadi F AD - Department of Medicine, Western University, London, ON, Canada. FAU - Zahrani, Mohammed AU - Zahrani M AD - Department of Medicine, Western University, London, ON, Canada. FAU - Bokhari, Mahmoud AU - Bokhari M AD - Department of Medicine, Western University, London, ON, Canada. FAU - Stirrat, John AU - Stirrat J AD - Robarts Research Institute, University of Western Ontario, London, ON, Canada. FAU - Yee, Raymond AU - Yee R AD - Department of Medicine, Western University, London, ON, Canada. FAU - Merchant, Naeem AU - Merchant N AD - Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute of Alberta, University of Calgary, #0700, SSB, Foothills Medical Centre, 1403-29th St. NW, Calgary, AB, T2N2T9, Canada. AD - Department of Cardiac Sciences, Libin Cardiovascular Institute, University of Calgary, Calgary, Canada. AD - Department of Diagnostic Imaging, University of Calgary, Calgary, Canada. FAU - Lydell, Carmen P AU - Lydell CP AD - Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute of Alberta, University of Calgary, #0700, SSB, Foothills Medical Centre, 1403-29th St. NW, Calgary, AB, T2N2T9, Canada. AD - Department of Cardiac Sciences, Libin Cardiovascular Institute, University of Calgary, Calgary, Canada. AD - Department of Diagnostic Imaging, University of Calgary, Calgary, Canada. FAU - Howarth, Andrew G AU - Howarth AG AD - Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute of Alberta, University of Calgary, #0700, SSB, Foothills Medical Centre, 1403-29th St. NW, Calgary, AB, T2N2T9, Canada. AD - Department of Cardiac Sciences, Libin Cardiovascular Institute, University of Calgary, Calgary, Canada. AD - Department of Diagnostic Imaging, University of Calgary, Calgary, Canada. FAU - White, James A AU - White JA AD - Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute of Alberta, University of Calgary, #0700, SSB, Foothills Medical Centre, 1403-29th St. NW, Calgary, AB, T2N2T9, Canada. jawhit@ucalgary.ca. AD - Department of Cardiac Sciences, Libin Cardiovascular Institute, University of Calgary, Calgary, Canada. jawhit@ucalgary.ca. AD - Department of Diagnostic Imaging, University of Calgary, Calgary, Canada. jawhit@ucalgary.ca. LA - eng PT - Journal Article PT - Validation Study DEP - 20161114 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 (Organometallic Compounds) RN - 1BJ477IO2L (gadobutrol) SB - IM MH - Adult MH - Aged MH - Cardiomyopathy, Dilated/*diagnostic imaging/mortality/pathology/therapy MH - Clinical Competence MH - Contrast Media/administration & dosage MH - Defibrillators, Implantable MH - Disease Progression MH - Disease-Free Survival MH - Electric Countershock/instrumentation MH - Feasibility Studies MH - Female MH - Fibrosis MH - Heart Septum/*diagnostic imaging/pathology MH - Humans MH - Kaplan-Meier Estimate MH - *Magnetic Resonance Imaging, Cine MH - Male MH - Middle Aged MH - Observer Variation MH - Organometallic Compounds/administration & dosage MH - Predictive Value of Tests MH - Proportional Hazards Models MH - Registries MH - Reproducibility of Results MH - Time Factors PMC - PMC5108079 OTO - NOTNLM OT - Cardiovascular magnetic resonance OT - Dilated cardiomyopathy OT - Fibrosis OT - Prognosis COIS- The authors declare that they have no competing interests. EDAT- 2016/11/15 06:00 MHDA- 2017/12/13 06:00 PMCR- 2016/11/14 CRDT- 2016/11/15 06:00 PHST- 2016/07/12 00:00 [received] PHST- 2016/10/28 00:00 [accepted] PHST- 2016/11/15 06:00 [entrez] PHST- 2016/11/15 06:00 [pubmed] PHST- 2017/12/13 06:00 [medline] PHST- 2016/11/14 00:00 [pmc-release] AID - S1097-6647(23)01023-2 [pii] AID - 300 [pii] AID - 10.1186/s12968-016-0300-z [doi] PST - epublish SO - J Cardiovasc Magn Reson. 2016 Nov 14;18(1):82. doi: 10.1186/s12968-016-0300-z.