Prognostic value of delayed gadolinium enhancement MRI in patients with ischemic cardiomyopathy

Cardiovascular magnetic resonance imaging (CMR) with delayed contrast enhancement (DCE) using Gadolinium (Gd)-based magnetic contrastagents, is a technique which visualizes myocardial infarction (MI) as regions of bright signal (hyperenhancement) compared to normal myocardium. The prognostic value of DCE in patients with ischemic cardiomyopathy has not been fully characterized.

All patients with a history of coronary artery disease (CAD) who underwent DCE-CMR imaging between September 1999 and July 2004 were included. CMR-variables were: left ventricular ejection fraction (LVEF), wall motion, mitral regurgitation (MR) and DCE scores. The patient's clinical status was assessed using the New York Heart Association-classification (NYHA).

One hundred and ninety-three patients (age 63+/-11, 42 women), including 160 with prior MI, were studied. The mean LVEF was 40+/-14%. Most patients (88%) were in NYHA-class I or II, and 8% had moderate or severe MR. Thirteen patients died during follow-up. Patients who died had a lower baseline LVEF and more significant MR compared to survivors (P=0.04). A higher DCE score was associated with more significant MR (P=0.01). No significant association was demonstrated between NYHA-class and DCE (P=0.34) or between DCE score andmortality (P=0. 8).

The study reinforces the important prognostic value of resting LVEF and MR severity in patients with CAD and is the first to demonstrate an association between the degree of DCE and MR severity in these patients. Further investigations including a larger number of patients are needed to fully assess the prognostic value of DCE-CMR in ischemic cardiomyopathy.