Author + information
- Received February 21, 2006
- Revision received May 25, 2006
- Accepted July 12, 2006
- Published online November 21, 2006.
- Ravi G. Assomull, MRCP⁎,†,2,
- Sanjay K. Prasad, MD, MRCP⁎,†,2,
- Jonathan Lyne, MRCP⁎,
- Gillian Smith, MSc⁎,
- Elizabeth D. Burman, MSc⁎,
- Mohammed Khan, MSc, MPH‡,
- Mary N. Sheppard, MD, FRCPath§,
- Philip A. Poole-Wilson, MD, FRCP† and
- Dudley J. Pennell, MD, FRCP, FESC, FACC⁎,†,⁎,1 ()
- ↵⁎Reprint requests and correspondence:
Dr. Dudley Pennell, Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, Sydney Street, London SW3 6NP, United Kingdom.
Objectives We studied the prognostic implications of midwall fibrosis in dilated cardiomyopathy (DCM) in a prospective longitudinal study.
Background Risk stratification of patients with nonischemic DCM in the era of device implantation is problematic. Approximately 30% of patients with DCM have midwall fibrosis as detected by late gadolinium-enhancement (LGE) cardiovascular magnetic resonance (CMR), which may increase susceptibility to arrhythmia and progression of heart failure.
Methods Consecutive DCM patients (n = 101) with the presence or absence of midwall fibrosis were followed up prospectively for 658 ± 355 days for events.
Results Midwall fibrosis was present in 35% of patients and was associated with a higher rate of the predefined primary combined end point of all-cause death and hospitalization for a cardiovascular event (hazard ratio 3.4, p = 0.01). Multivariate analysis showed midwall fibrosis as the sole significant predictor of death or hospitalization. However, there was no significant difference in all-cause mortality between the 2 groups. Midwall fibrosis also predicted secondary outcome measures of sudden cardiac death (SCD) or ventricular tachycardia (VT) (hazard ratio 5.2, p = 0.03). Midwall fibrosis remained predictive of SCD/VT after correction for baseline differences in left ventricular ejection fraction between the 2 groups.
Conclusions In DCM, midwall fibrosis determined by CMR is a predictor of the combined end point of all-cause mortality and cardiovascular hospitalization, which is independent of ventricular remodeling. In addition, midwall fibrosis by CMR predicts SCD/VT. This suggests a potential role for CMR in the risk stratification of patients with DCM, which may have value in determining the need for device therapy.
↵1 Dr. Pennell is a consultant to Siemens and a Director of Cardiovascular Imaging Solutions, Ltd.
↵2 Drs. Assomull and Prasad contributed equally to this research.
This study was supported by the British Heart Foundation (fellowship for Dr Assomull), CORDA, the Trust Funds of Royal Brompton Hospital, and Siemens Medical Systems.
- Received February 21, 2006.
- Revision received May 25, 2006.
- Accepted July 12, 2006.
- American College of Cardiology Foundation