학술논문
1342Myocardial remodelling and fibrosis in nonischaemic dilated cardiomyopathy: insights from cardiovascular magnetic resonance
Document Type
Academic Journal
Author
Source
European Heart Journal – Cardiovascular Imaging. May 01, 2016 17(suppl_1 Suppl 1):i1-i80
Subject
Language
English
ISSN
2047-2404
Abstract
Background: In nonischaemic dilated cardiomyopathy (DCM), myocardial fibrosis can be detected by cardiovascular magnetic resonance (CMR) as late gadolinium enhancement (LGE) and has been associated with worse prognosis. We investigated whether LGE is associated with left ventricular (LV) reverse remodelling in DCM.Methods: Ninety-seven DCM patients (age 56 ± 14 years, 62 male) with LV ejection fraction ≤50% were enrolled and underwent baseline CMR; patients with ischaemic, valvular, congenital heart disease, other cardiomyopathies or contraindications to CMR were excluded. After a median 29-month follow-up (interquartile range 16-46) on optimal medical therapy, all patients underwent a second CMR; patients who died, underwent device implantation or declined a second CMR, were also excluded from the study. LGE was quantified on post-contrast CMR images as percentage of LV mass. LV reverse remodelling was defined as a decrease >10% of LV end-systolic volume at follow-up.Results: Mean LV ejection fraction was 37 ± 10% at baseline, 44 ± 12% at follow-up. LGE was present in 56 (58%) patients at baseline (median 6% of LV mass, interquartile range 3-11%), without significant differences at follow-up (median 7%, interquartile range 4-11%, p = NS). Patients experiencing LV reverse remodelling during follow-up (n = 53, 55%) presented a baseline worse LV ejection fraction (34 ± 11%) than patients not experiencing LV reverse remodelling (41 ± 8%, p < 0.01), greater LV end-diastolic volume (125 ± 38 vs. 112 ± 26 ml/m2, p = 0.05), worse right ventricular ejection fraction (54 ± 13% vs. 59 ± 10%, p = 0.03), but significantly less fibrosis (median 5% of LV mass, interquartile range 2-9% vs. median 9%, interquartile range 3-15%, p < 0.01); no age or gender differences were observed (p = NS). Multivariate regression analysis showed that LGE extent at baseline CMR was a negative predictor of LV reverse remodelling (p < 0.01), even after correction for age, New York Heart Association class, LV volumes and systolic function.Conclusions: In DCM patients, LGE extent was a negative independent predictor of LV reverse during follow-up, irrespective of the initial clinical status and the severity of ventricular dysfunction.