JACC
HOME SUBSCRIPTIONS CURRENT ISSUE PAST ISSUES CARDIOSOURCE SEARCH HELP FEEDBACK
QUICK SEARCH:   [advanced]


     

J Am Coll Cardiol, 2006; 48:1977-1985, doi:10.1016/j.jacc.2006.07.049 (Published online 31 October 2006).
© 2006 by the American College of Cardiology Foundation
This Article
Right arrow Figures Only
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow All Versions of this Article:
j.jacc.2006.07.049v1
48/10/1977    most recent
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in ISI Web of Science
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via ISI Web of Science (29)
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Assomull, R. G.
Right arrow Articles by Pennell, D. J.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Assomull, R. G.
Right arrow Articles by Pennell, D. J.
Related Collections
Right arrowRelated Article

CLINICAL RESEARCH: DELAYED ENHANCEMENT MAGNETIC RESONANCE

Cardiovascular Magnetic Resonance, Fibrosis, and Prognosis in Dilated Cardiomyopathy

Ravi G. Assomull, MRCP*,{dagger},2, Sanjay K. Prasad, MD, MRCP*,{dagger},2, Jonathan Lyne, MRCP*, Gillian Smith, MSc*, Elizabeth D. Burman, MSc*, Mohammed Khan, MSc, MPH{ddagger}, Mary N. Sheppard, MD, FRCPath§, Philip A. Poole-Wilson, MD, FRCP{dagger} and Dudley J. Pennell, MD, FRCP, FESC, FACC*,{dagger},*,1

* Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London, United Kingdom
{dagger} National Heart and Lung Institute, Imperial College, London, United Kingdom
{ddagger} Medical Statistics Unit, Royal Brompton Hospital, London, United Kingdom
§ Pathology Department, Royal Brompton Hospital, London, United Kingdom.

Manuscript received February 21, 2006; revised manuscript received May 25, 2006, accepted July 12, 2006.

* Reprint requests and correspondence: Dr. Dudley Pennell, Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, Sydney Street, London SW3 6NP, United Kingdom. (Email: d.pennell{at}imperial.ac.uk).

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.

Abbreviations and Acronyms
  CAD = coronary artery disease
  CI = confidence interval
  CMR = cardiovascular magnetic resonance
  CRT = cardiac resynchronization therapy
  DCM = dilated cardiomyopathy
  EDV = end-diastolic volume
  EF = ejection fraction
  ESV = end-systolic volume
  LGE = late gadolinium enhancement
  LV = left ventricle/ventricular
  RV = right ventricle/ventricular
  SCD = sudden cardiac death
  VT = ventricular tachycardia


Related Article

The Expanding Prognostic Role of Late Gadolinium Enhanced Cardiac Magnetic Resonance
Christopher M. Kramer
J. Am. Coll. Cardiol. 2006 48: 1986-1987. [Full Text] [PDF]



This article has been cited by other articles:


Home page
 Circ Cardiovasc ImagingHome page
T. H. Marwick and M. Schwaiger
The Future of Cardiovascular Imaging in the Diagnosis and Management of Heart Failure, Part 1: Tasks and Tools
Circ Cardiovasc Imaging, July 1, 2008; 1(1): 58 - 69.
[Full Text] [PDF]

Home page
 J Am Coll Cardiol ImgHome page
B. J. Schietinger, G. M. Brammer, H. Wang, J. M. Christopher, K. W. Kwon, A. J. Mangrum, J. M. Mangrum, and C. M. Kramer
Patterns of Late Gadolinium Enhancement in Chronic Hemodialysis Patients
J. Am. Coll. Cardiol. Img., July 1, 2008; 1(4): 450 - 456.
[Abstract] [Full Text] [PDF]

Home page
 J Am Coll CardiolHome page
K. C. Wu, R. G. Weiss, D. R. Thiemann, K. Kitagawa, A. Schmidt, D. Dalal, S. Lai, D. A. Bluemke, G. Gerstenblith, E. Marban, et al.
Late gadolinium enhancement by cardiovascular magnetic resonance heralds an adverse prognosis in nonischemic cardiomyopathy.
J. Am. Coll. Cardiol., June 24, 2008; 51(25): 2414 - 2421.
[Abstract] [Full Text] [PDF]

Home page
 Eur Heart JHome page
L. Di Biase, A. Auricchio, A. Sorgente, K. Civello, C. Klersy, F. Faletra, L. Riedlbauchova, D. Patel, M. Arruda, R. A. Schweikert, et al.
The magnitude of reverse remodelling irrespective of aetiology predicts outcome of heart failure patients treated with cardiac resynchronization therapy
Eur. Heart J., May 30, 2008; (2008) ehn221v1.
[Abstract] [Full Text] [PDF]

Home page
 J Am Coll CardiolHome page
A. S. Adabag, B. J. Maron, E. Appelbaum, C. J. Harrigan, J. L. Buros, C. M. Gibson, J. R. Lesser, C. A. Hanna, J. E. Udelson, W. J. Manning, et al.
Occurrence and Frequency of Arrhythmias in Hypertrophic Cardiomyopathy in Relation to Delayed Enhancement on Cardiovascular Magnetic Resonance
J. Am. Coll. Cardiol., April 8, 2008; 51(14): 1369 - 1374.
[Abstract] [Full Text] [PDF]

Home page
 J Am Coll CardiolHome page
S. Nazarian and J. A.C. Lima
Cardiovascular Magnetic Resonance for Risk Stratification of Arrhythmia in Hypertrophic Cardiomyopathy
J. Am. Coll. Cardiol., April 8, 2008; 51(14): 1375 - 1376.
[Full Text] [PDF]

Home page
 HeartHome page
T. Germans and A. C van Rossum
The use of cardiac magnetic resonance imaging to determine the aetiology of left ventricular disease and cardiomyopathy
Heart, April 1, 2008; 94(4): 510 - 518.
[Full Text] [PDF]

Home page
 J Am Coll CardiolHome page
L. E.J. Thomson
Cardiovascular magnetic resonance in clinically suspected cardiac amyloidosis: diagnostic value of a typical pattern of late gadolinium enhancement.
J. Am. Coll. Cardiol., March 11, 2008; 51(10): 1031 - 1032.
[Full Text] [PDF]

Home page
 RadiologyHome page
V. R. S. Fernandes, K. C. Wu, B. D. Rosen, A. Schmidt, A. C. Lardo, N. Osman, H. R. Halperin, G. Tomaselli, R. Berger, D. A. Bluemke, et al.
Enhanced Infarct Border Zone Function and Altered Mechanical Activation Predict Inducibility of Monomorphic Ventricular Tachycardia in Patients with Ischemic Cardiomyopathy
Radiology, December 1, 2007; 245(3): 712 - 719.
[Abstract] [Full Text] [PDF]

Home page
 EuropaceHome page
S. Chalil, P. W.X. Foley, S. A. Muyhaldeen, K. C.R. Patel, Z. R. Yousef, R. E.A. Smith, M. P. Frenneaux, and F. Leyva
Late gadolinium enhancement-cardiovascular magnetic resonance as a predictor of response to cardiac resynchronization therapy in patients with ischaemic cardiomyopathy
Europace, November 1, 2007; 9(11): 1031 - 1037.
[Abstract] [Full Text] [PDF]

Home page
 EuropaceHome page
K. H.W.J. Ten Tusscher and A. V. Panfilov
Influence of diffuse fibrosis on wave propagation in human ventricular tissue
Europace, November 1, 2007; 9(suppl_6): vi38 - vi45.
[Abstract] [Full Text] [PDF]

Home page
 CirculationHome page
F. E. Marchlinski
Perivalvular Fibrosis and Monomorphic Ventricular Tachycardia: Toward a Unifying Hypothesis in Nonischemic Cardiomyopathy
Circulation, October 30, 2007; 116(18): 1998 - 2001.
[Full Text] [PDF]

Home page
 J Am Coll CardiolHome page
R. J. Gibbons, P. A. Araoz, and E. E. Williamson
The Year in Cardiac Imaging
J. Am. Coll. Cardiol., September 4, 2007; 50(10): 988 - 1003.
[Full Text] [PDF]

Home page
 J Am Coll CardiolHome page
W. O. Ntim and W. G. Hundley
Cardiac Imaging in Patients With Chronic Obstructive Pulmonary Disease and Chronic Heart Failure
J. Am. Coll. Cardiol., May 8, 2007; 49(18): 1900 - 1901.
[Full Text] [PDF]

Home page
 Eur Heart JHome page
E. Marijon and A. Redheuil
Non-invasive 'tissue characterization approach' for congenital ventricular outpouchings: role of magnetic resonance with delayed contrast-enhanced imaging
Eur. Heart J., April 2, 2007; 28(8): 1040 - 1040.
[Full Text] [PDF]

Home page
 J Am Coll CardiolHome page
A. N. DeMaria, O. Ben-Yehuda, G. K. Feld, G. S. Ginsburg, B. H. Greenberg, W. Y.W. Lew, J. A.C. Lima, A. S. Maisel, J. Narula, D. J. Sahn, et al.
Highlights of the Year in JACC 2006
J. Am. Coll. Cardiol., January 30, 2007; 49(4): 509 - 527.
[Full Text] [PDF]

Home page
 J Am Coll CardiolHome page
C. M. Kramer
The Expanding Prognostic Role of Late Gadolinium Enhanced Cardiac Magnetic Resonance
J. Am. Coll. Cardiol., November 21, 2006; 48(10): 1986 - 1987.
[Full Text] [PDF]


HOME SUBSCRIPTIONS CURRENT ISSUE PAST ISSUES CARDIOSOURCE SEARCH HELP FEEDBACK
Copyright © 2006 by the American College of Cardiology Foundation.