Effects of myocardial fibrosis and ventricular dyssynchrony on response to therapy in new-presentation idiopathic dilate
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POSTER PRESENTATION
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Effects of myocardial fibrosis and ventricular dyssynchrony on response to therapy in new-presentation idiopathic dilated cardiomyopathy: insights from cardiovascular magnetic resonance and echocardiography Darryl P Leong1*, Adhiraj Chakrabarty2, Nicholas Shipp3, Payman Molaee3, Per Lav Madsen4, Lucas Joerg4, Thomas Sullivan5, Hugh Greville6, Stephen G Worthley3, Carmine G De Pasquale4, Prashanthan Sanders3, Joseph B Selvanayagam2 From 2011 SCMR/Euro CMR Joint Scientific Sessions Nice, France. 3-6 February 2011 Objectives To determine whether the extent of myocardial fibrosis by late-gadolinium enhancement cardiovascular magnetic resonance (LGE-CMR), and echocardiographic ventricular dyssynchrony can independently predict response to medical therapy in patients with newly-diagnosed idiopathic dilated cardiomyopathy (DCM). Background Myocardial fibrosis and ventricular dyssynchrony are frequent findings in DCM. Although previous studies have reported poor prognosis with the presence of myocardial fibrosis in DCM, they focussed on patients with established cardiomyopathy, and did not characterise patients early in the disease course and may not have included those with significant improvement in LV function soon after diagnosis. Hence, the degree of myocardial fibrosis and ventricular dyssynchrony at initial presentation, and their role in perpetuating left ventricular (LV) dysfunction in DCM remains unclear. We hypothesised that extent of myocardial fibrosis by the LGE-CMR technique and echocardiographic ventricular dyssynchrony are independent predictors of failure of improvement in LV function in new-onset DCM. 1 Department of Cardiovascular Medicine, Flinders Medical Centre, Adelaide, Australia, The University of Adelaide, Adelaide, Australia, The Flinders University of South Australia, Adelaide, Australia Full list of author information is available at the end of the article
Methods Patients with a new diagnosis of DCM (LV ejection fraction (EF) ≤45%) made within the preceding two weeks were recruited. Patients underwent LGE-CMR, echocardiography, 6-minute-walk testing, cardiopulmonary exercise testing, and blood sampling for measurement of serum NT-pro-BNP concentration at baseline. Baseline patient characteristics were compared with a cohort of healthy volunteers. Myocardial fibrosis by LGE-CMR was identified by experienced observers blinded to patient outcome, and was quantified by planimetry for calculation of fibrosis mass. LV systolic function was reassessed after 5 months optimal medical therapy. Results Sixty-eight patients with DCM and 19 healthy volunteers were studied. DCM patients were studied a median 12.5 days following diagnosis. Compared to healthy controls, DCM patients exhibited poorer functional capacity, higher serum NT-pro-BNP concentration, and greater inter- and intraventricular dyssynchrony. Twenty-four percent of DCM patients exhibited LGE at diagnosis, whereas no LGE was observed amongst controls. Within DCM patients with LGE, the mean fibrosis mass wa
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