Takashi Yamada1, Akihiro Hirashiki2, Takahiro Okumura1, Shiro Adachi1, Shuzo Shimazu1, Shinya Shimizu1, Ryota Morimoto1, Kyosuke Takeshita1, Shinji Naganawa3, Takahisa Kondo4, Toyoaki Murohara1. 1. Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan. 2. Department of Advanced Medicine in Cardiopulmonary Disease, Nagoya University Graduate School of Medicine, Nagoya, Japan. Electronic address: hirasiki@med.nagoya-u.ac.jp. 3. Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya, Japan. 4. Department of Advanced Medicine in Cardiopulmonary Disease, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Abstract
BACKGROUND: Peak oxygen consumption (peak VO₂) and late gadolinium enhancement (LGE) on cardiovascular magnetic resonance (CMR) are prognostic in heart failure. We investigated whether LGE-CMR and peak VO₂combined had additive value in risk stratifying patients with nonischemic dilated cardiomyopathy (DCM). METHODS AND RESULTS: Fifty-seven DCM patients underwent CMR and cardiopulmonary exercise testing. Cardiac events were cardiac death, hospitalization for decompensated heart failure, or lethal arrhythmia. Twenty-five (44%) were LGE-positive. The median peak VO₂was 18.5 mL·kg(-1)·min(-1). On multivariate analysis, positive LGE (P = .048) and peak VO₂(P = .003) were independent cardiac event predictors. Cardiac event risk was significantly higher with positive LGE and peak VO₂< 18.5 mL ·kg⁻¹ ·min⁻¹ than with negative LGE and peak VO₂≥ 18.5 mL · kg⁻¹ · min⁻¹ (hazard ratio 12.5; 95% CI 1.57-100; P = .017). In 3 patient groups (group A: no LGE, peak VO₂≥ 18.5 mL · kg⁻¹ · min⁻¹, n = 18; group B: positive LGE or peak VO₂< 18.5 mL · kg⁻¹ · min⁻¹, n = 24; group C: positive LGE and peak VO₂< 18.5 mL · kg⁻¹ · min⁻¹, n = 15) during follow-up (71 ± 32 months), group C had higher cardiac event rates than the others. CONCLUSIONS: Combined assessment of LGE-CMR and peak VO₂provides additive prognostic information in ambulatory DCM.
BACKGROUND: Peak oxygen consumption (peak VO₂) and late gadolinium enhancement (LGE) on cardiovascular magnetic resonance (CMR) are prognostic in heart failure. We investigated whether LGE-CMR and peak VO₂combined had additive value in risk stratifying patients with nonischemic dilated cardiomyopathy (DCM). METHODS AND RESULTS: Fifty-seven DCMpatients underwent CMR and cardiopulmonary exercise testing. Cardiac events were cardiac death, hospitalization for decompensated heart failure, or lethal arrhythmia. Twenty-five (44%) were LGE-positive. The median peak VO₂was 18.5 mL·kg(-1)·min(-1). On multivariate analysis, positive LGE (P = .048) and peak VO₂(P = .003) were independent cardiac event predictors. Cardiac event risk was significantly higher with positive LGE and peak VO₂< 18.5 mL ·kg⁻¹ ·min⁻¹ than with negative LGE and peak VO₂≥ 18.5 mL · kg⁻¹ · min⁻¹ (hazard ratio 12.5; 95% CI 1.57-100; P = .017). In 3 patient groups (group A: no LGE, peak VO₂≥ 18.5 mL · kg⁻¹ · min⁻¹, n = 18; group B: positive LGE or peak VO₂< 18.5 mL · kg⁻¹ · min⁻¹, n = 24; group C: positive LGE and peak VO₂< 18.5 mL · kg⁻¹ · min⁻¹, n = 15) during follow-up (71 ± 32 months), group C had higher cardiac event rates than the others. CONCLUSIONS: Combined assessment of LGE-CMR and peak VO₂provides additive prognostic information in ambulatory DCM.
Authors: Laura Keil; Céleste Chevalier; Paulus Kirchhof; Stefan Blankenberg; Gunnar Lund; Kai Müllerleile; Christina Magnussen Journal: Int J Mol Sci Date: 2021-07-01 Impact factor: 5.923