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Midwall fibrosis predicted death risk in LVEF patients
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Detection of midwall fibrosis by late gadolinium enhancement CV MRI among patients with nonischemic dilated cardiomyopathy was associated with an increased likelihood of death, according to results of a new study.
Researchers analyzed 472 patients with dilated cardiomyopathy referred for late gadolinium enhancement CV MRI between November 2000 and December 2008. The researchers determined the presence and extent of midwall replacement fibrosis. All patients were followed up through December 2011.
Ankur Gulati
Seventy-three deaths occurred during a mean follow-up of 5.3 years. Patients with midwall fibrosis had a higher rate of death compared with patients with no midwall fibrosis (26.8% vs. 10.6%).
After adjustment for left ventricular ejection fraction and other conventional prognostic factors, the extent (HR=1.11; 95% CI, 1.06-1.16) and presence (HR=2.43; 95% CI, 1.50-3.92) of midwall fibrosis were significant, independent predictors of all-cause mortality, according to a press release.
The arrhythmic composite endpoint of sudden cardiac death or aborted sudden cardiac death occurred in 14% of patients. Researchers found that patients with midwall fibrosis were at least five times more likely to experience sudden cardiac death or aborted sudden cardiac death compared with patients with no midwall fibrosis (29.6% vs. 7%). In addition, midwall fibrosis also was independently associated with CV mortality, cardiac transplantation and a composite of HF death, HF hospitalization or cardiac transplantation.
Adding fibrosis to LVEF significantly improved the risk reclassification for all-cause mortality and sudden card death composite (net reclassification improvement: 0.26 and 0.29, respectively).
“[Late gadolinium enhancement CV MRI] improved risk stratification beyond LVEF for all-cause mortality and sudden cardiac death,” Ankur Gulati, MD, of Royal Brompton Hospital, London, and colleagues wrote in JAMA. “The potential clinical utility of midwall fibrosis evaluated by [late gadolinium enhancement CV MRI] in the risk stratification of patients with dilated cardiomyopathy requires further investigation.”
Disclosure:Gulati reports receiving funding from the National Institute for Health Research, CORDA and Rosetrees Trust.
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