Yuanwei Xu1, Weihao Li1, Ke Wan2, Yaodan Liang1,3, Xincheng Jiang1, Jie Wang1, David Mui4, Yangjie Li1, Siqi Tang1, Jiajun Guo1, Xinli Guo1, Xiumin Liu5, Jiayu Sun5, Qing Zhang1, Yuchi Han4, Yucheng Chen1. 1. Department of Cardiology (Y.X., W.L., Y. Liang, X.J., J.W., Y. Li, S.T., J.G., X.G., Q.Z., Y.C.), West China Hospital, Sichuan University, Chengdu, China. 2. Department of Geriatrics (K.W.), West China Hospital, Sichuan University, Chengdu, China. 3. Department of Pulmonary and Critical Care Medicine, Beijing Hospital, National Center of Gerontology, China (Y. Liang). 4. Cardiovascular Division, Departments of Medicine and Radiology, University of Pennsylvania, Philadelphia (D.M., Y.H.). 5. Department of Radiology (X.L., J.S.), West China Hospital, Sichuan University, Chengdu, China.
Abstract
BACKGROUND: The prognosis of patients with idiopathic dilated cardiomyopathy (DCM) has improved remarkably in recent decades with guideline-directed medical therapy. Left ventricular (LV) reverse remodeling (LVRR) is one of the major therapeutic goals. Whether myocardial fibrosis or inflammation would reverse associated with LVRR remains unknown. METHODS: A total of 157 prospectively enrolled patients with DCM underwent baseline and follow-up cardiovascular magnetic resonance examinations with a median interval of 13.7 months (interquartile range, 12.2-18.5 months). LVRR was defined as an absolute increase in LV ejection fraction of >10% to the final value of ≥35% and a relative decrease in LV end-diastolic volume of >10%. Statistical analyses were performed using paired t test and student t test, logistic regression analysis, and linear regression analysis. RESULTS: Forty-eight (31%) patients reached LVRR. At baseline, younger age, worse New York Heart Association class, new-onset heart failure, lower LV ejection fraction, absence of late gadolinium enhancement, lower myocardial T2, and extracellular volume were significant predictors of LVRR. During the follow-up, patients with and without LVRR both showed a significant decrease of myocardial native T1 (LVRR: [baseline] 1303.0±43.6 ms; [follow-up] 1244.7±51.8 ms; without LVRR: [baseline] 1308.5±80.5 ms; [follow-up] 1287.6±74.9 ms, both P<0.001), matrix and cellular volumes while no significant difference was observed in T2 or extracellular volume values after treatment. CONCLUSIONS: In patients with idiopathic DCM, the absence of late gadolinium enhancement, lower T2, and extracellular volume values at baseline are significant predictors of LVRR. The myocardial T1, matrix, and cell volume decrease significantly in patients with LVRR after guideline-directed medical therapy. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: ChiCTR1800017058.
BACKGROUND: The prognosis of patients with idiopathic dilated cardiomyopathy (DCM) has improved remarkably in recent decades with guideline-directed medical therapy. Left ventricular (LV) reverse remodeling (LVRR) is one of the major therapeutic goals. Whether myocardial fibrosis or inflammation would reverse associated with LVRR remains unknown. METHODS: A total of 157 prospectively enrolled patients with DCM underwent baseline and follow-up cardiovascular magnetic resonance examinations with a median interval of 13.7 months (interquartile range, 12.2-18.5 months). LVRR was defined as an absolute increase in LV ejection fraction of >10% to the final value of ≥35% and a relative decrease in LV end-diastolic volume of >10%. Statistical analyses were performed using paired t test and student t test, logistic regression analysis, and linear regression analysis. RESULTS: Forty-eight (31%) patients reached LVRR. At baseline, younger age, worse New York Heart Association class, new-onset heart failure, lower LV ejection fraction, absence of late gadolinium enhancement, lower myocardial T2, and extracellular volume were significant predictors of LVRR. During the follow-up, patients with and without LVRR both showed a significant decrease of myocardial native T1 (LVRR: [baseline] 1303.0±43.6 ms; [follow-up] 1244.7±51.8 ms; without LVRR: [baseline] 1308.5±80.5 ms; [follow-up] 1287.6±74.9 ms, both P<0.001), matrix and cellular volumes while no significant difference was observed in T2 or extracellular volume values after treatment. CONCLUSIONS: In patients with idiopathic DCM, the absence of late gadolinium enhancement, lower T2, and extracellular volume values at baseline are significant predictors of LVRR. The myocardial T1, matrix, and cell volume decrease significantly in patients with LVRR after guideline-directed medical therapy. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: ChiCTR1800017058.
Entities:
Keywords:
cardiomyopathy, dilated; heart failure; inflammation; magnetic resonance; myocardium
Authors: Aaron T O'Brien; Katarzyna E Gil; Juliet Varghese; Orlando P Simonetti; Karolina M Zareba Journal: J Cardiovasc Magn Reson Date: 2022-06-06 Impact factor: 6.903
Authors: Anne G Raafs; Job A J Verdonschot; Michiel T H M Henkens; Bouke P Adriaans; Ping Wang; Kasper Derks; Myrurgia A Abdul Hamid; Christian Knackstedt; Vanessa P M van Empel; Javier Díez; Hans-Peter Brunner-La Rocca; Han G Brunner; Arantxa González; Sebastiaan C A M Bekkers; Stephane R B Heymans; Mark R Hazebroek Journal: Eur J Heart Fail Date: 2021-06-24 Impact factor: 15.534