Prognostic significance of magnetic resonance imaging parameters in patients with idiopathic dilated cardiomyopathy

Background

Patients with idiopathic dilated cardiomyopathy (IDC) have a limited prognosis. Aim of this study was to evaluate the prognostic significance of novel magnetic resonance imaging (CMR) parameters in IDC patients.

Methods and results

161 patients with IDC were studied by CMR for hemodynamic and late enhancement (LE) analysis and followed for a mean of 933,8 ± 529,2 days. QRS and QTc intervals were measured from 12-lead ECGs. LV and RV enddiastolic and endsystolic volume indexes were increased and ejection fractions (EF) decreased (LV-EF 33 ± 14%, RV-EF 50 ± 16%). LE was seen in 43 patients (27%). Interventricular dyssynchrony (50.9 ± 67.2 ms) was present in 68 patients (42%). Primary endpoint was cardiac death, sudden death (SCD) and rehospitalization for pump failure, secondary endpoint cardiac death and SCD. 3 patients died from non-cardiac, 10 patients from cardiac death, 2 patients from SCD and additional 3 patients had ICD shock for ventricular flutter/fibrillation, and 35 patients were rehospitalized. Multivariate analysis revealed depressed left ventricular EF(<25%) right ventricular EF (<30%), as well as the presence of LE as independent prognostic parameters. Kaplan-Meier survival analysis displayed low LV (<25%) and RV (<30%) ejection fraction and the presence of LE as significant parameters for a worse outcome.

Conclusion

In addition to impaired left ventricular ejection fraction (<25–30%) a depressed right ventricular function (EF <30%) and the presence of late enhancement derived from CMR are novel prognostic parameters in patients with IDCM.