MRI and serum high-sensitivity C reactive protein predict long-term mortality in non-ischaemic cardiomyopathy
Taketaro Sadahiro1, Shun Kohsaka1, Shigeo Okuda2
1Department of Cardiology , Keio University School of Medicine , Tokyo, Shinjuku-ku , Japan.
Objective:
Myocardial fibrosis related to non-specific inflammation can be detected using late gadolinium-enhancement cardiovascular MR (LGE-CMR), which is an important prognostic indicator for dilated cardiomyopathy (DCM). The aims of this study were to define the prognostic factors for DCM with LGE-CMR, and to evaluate the impact of the prognostic factors on adverse effects.
Methods:
We performed a retrospective analysis of a prospectively maintained single centre registry. We analysed the data from 76 patients with DCM who had been admitted for acute heart failure. The primary combined end point was defined as all-cause mortality and rehospitalisation.
Results:
LGE-CMR was present in 39 patients (51%), and the mean follow-up period was 813±54 days. The primary end point occurred in 20 patients (5 (13.5%) patients without LGE-CMR and 15 (38.5%) patients with LGE-CMR, p=0.006). Sixteen of 39 patients with LGE-CMR exhibited elevated high-sensitivity C reactive protein (hs-CRP >0.3 mg/dL). Patients with elevated hs-CRP and LGE-CMR had a significantly higher incidence of the primary end point compared with patients with normal hs-CRP and LGE-CMR (62.5%; 10 patients, 22.7%; 5 patients, respectively, p=0.001). Elevated hs-CRP was significantly associated with the primary end point (HR: 4.04; 95% CI 1.67 to 9.76; p=0.002). After elevated hs-CRP was adjusted for known predictors of DCM, it was still associated with the primary end point (HR: 2.91; 95% CI 1.19 to 7.15; p=0.02).
Conclusions:
Among patients with DCM, LGE-CMR and elevated hs-CRP are associated with a higher incidence of the long-term combined end point of all-cause mortality and hospitalisation.
Trial Registration Number:
UMIN000001171.
Insights
Late gadolinium-enhancement cardiovascular MR (LGE-CMR) and elevated high-sensitivity C-reactive protein (hs-CRP) indicate a higher risk of mortality and rehospitalization in dilated cardiomyopathy patients. These findings highlight key prognostic factors for adverse outcomes in DCM.
Area of Science:
- Cardiology
- Medical Imaging
- Biomarkers
Background:
- Dilated cardiomyopathy (DCM) prognosis is significantly influenced by myocardial fibrosis, detectable via late gadolinium-enhancement cardiovascular MR (LGE-CMR).
- Non-specific inflammation plays a role in myocardial fibrosis, impacting DCM outcomes.
Purpose of the Study:
- To identify prognostic factors for DCM using LGE-CMR.
- To assess the impact of these prognostic factors on adverse events, including mortality and rehospitalization.
Main Methods:
- Retrospective analysis of 76 DCM patients admitted for acute heart failure.
- Primary endpoint: composite of all-cause mortality and rehospitalization.
- LGE-CMR and high-sensitivity C-reactive protein (hs-CRP) levels were analyzed.
Main Results:
- LGE-CMR was present in 51% of patients and associated with a higher incidence of the primary endpoint (38.5% vs 13.5%).
- Elevated hs-CRP (>0.3 mg/dL) combined with LGE-CMR significantly increased the primary endpoint incidence (62.5% vs 22.7%).
- Elevated hs-CRP independently predicted adverse outcomes (HR: 2.91, p=0.02).
Conclusions:
- LGE-CMR and elevated hs-CRP are significant indicators of adverse outcomes in DCM patients.
- These markers are associated with an increased risk of long-term mortality and hospitalisation.
- The combination of LGE-CMR and hs-CRP provides critical prognostic information for DCM management.
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