Left Ventricular Geometry and Replacement Fibrosis Detected by cMRI Are Associated with Major Adverse Cardiovascular Events in Nonischemic Dilated Cardiomyopathy

Bianca Olivia Cojan-Minzat; Alexandru Zlibut; Ioana Danuta Muresan; Carmen Cionca; Dalma Horvat; Eva Kiss; Radu Revnic; Mira Florea; Razvan Ciortea; Lucia Agoston-Coldea

doi:10.3390/jcm9061997

Left Ventricular Geometry and Replacement Fibrosis Detected by cMRI Are Associated with Major Adverse Cardiovascular Events in Nonischemic Dilated Cardiomyopathy

J Clin Med. 2020 Jun 25;9(6):1997. doi: 10.3390/jcm9061997.

Authors

Bianca Olivia Cojan-Minzat^{1

2}, Alexandru Zlibut¹, Ioana Danuta Muresan¹, Carmen Cionca³, Dalma Horvat¹, Eva Kiss¹, Radu Revnic², Mira Florea², Razvan Ciortea^{1

4}, Lucia Agoston-Coldea^{1

3

5}

Affiliations

¹ Department of Internal Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania.
² Department of Family Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, 400001 Cluj-Napoca, Romania.
³ Department of Radiology, Affidea Hiperdia Diagnostic Imaging Center, 400015 Cluj-Napoca, Romania.
⁴ Department of Obstetrics and Gynecology, Emergency County Hospital, 400124 Cluj-Napoca, Romania.
⁵ 2nd Department of Internal Medicine, Emergency County Hospital, 400006 Cluj-Napoca, Romania.

Abstract

To investigate the relationship between left ventricular (LV) long-axis strain (LAS) and LV sphericity index (LVSI) and outcomes in patients with nonischemic dilated cardiomyopathy (NIDCM) and myocardial replacement fibrosis confirmed by late gadolinium enhancement (LGE) using cardiac magnetic resonance imaging (cMRI), we conducted a prospective study on 178 patients (48 ± 14.4 years; 25.2% women) with first NIDCM diagnosis. The evaluation protocol included ECG monitoring, echocardiography and cMRI. LAS and LVSI were cMRI-determined. Major adverse cardiovascular events (MACEs) were defined as a composite outcome including heart failure (HF), ventricular arrhythmias (VAs) and sudden cardiac death (SCD). After a median follow-up of 17 months, patients with LGE+ had increased risk of MACEs. Kaplan-Meier curves showed significantly higher rate of MACEs in patients with LGE+ (p < 0.001), increased LVSI (p < 0.01) and decreased LAS (p < 0.001). In Cox analysis, LAS (HR = 1.32, 95%CI (1.54-9.14), p = 0.001), LVSI [HR = 1.17, 95%CI (1.45-7.19), p < 0.01] and LGE+ (HR = 1.77, 95%CI (2.79-12.51), p < 0.0001) were independent predictors for MACEs. In a 4-point risk scoring system based on LV ejection fraction (LVEF) < 30%, LGE+, LAS > -7.8% and LVSI > 0.48%, patients with 3 and 4 points had a significantly higher risk for MACEs. LAS and LVSI are independent predictors of MACEs and provide incremental value beyond LVEF and LGE+ in patients with NIDCM and myocardial fibrosis.

Keywords: cardiac magnetic resonance imaging; late gadolinium enhancement; left ventricle sphericity index; long axis strain; major adverse cardiovascular events; nonischemic dilated cardiomyopathy.