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Predictors of left ventricular remodelling in patients with dilated cardiomyopathy - a cardiovascular magnetic

Upasana Tayal1,2, Ricardo Wage2, Simon Newsome3

  • 1National Heart Lung Institute, Imperial College London, UK.

European Journal of Heart Failure
|February 15, 2020
PubMed

Insights

Left ventricular (LV) remodelling in dilated cardiomyopathy (DCM) can be predicted by LV contractile reserve. Low LV contractile reserve indicates a reduced likelihood of LV ejection fraction (LVEF) recovery in DCM patients.

Area of Science:

  • Cardiology
  • Biomarkers
  • Cardiovascular Imaging

Background:

  • Dilated cardiomyopathy (DCM) is a significant condition requiring improved biomarkers for predicting left ventricular (LV) remodelling.
  • Accurate prediction of LV remodelling is crucial for managing DCM and optimizing patient outcomes.

Purpose of the Study:

  • To comprehensively assess cardiac structure and myocardial composition to identify predictors of LV remodelling in recent-onset DCM.
  • To determine the relationship between baseline cardiac parameters and the change in LV ejection fraction (LVEF) over 12 months.

Main Methods:

  • A prospective study involving patients with recent-onset DCM and controls, utilizing cardiovascular magnetic resonance (CMR).
  • CMR assessments included ventricular structure and function, extracellular volume (T1 mapping), myocardial strain, late gadolinium enhancement (scar), and dobutamine stress for contractile reserve.
  • Regression analyses were performed to identify predictors of LVEF change over 12 months.

Main Results:

  • Absolute LV contractile reserve was a significant predictor of LVEF change at 12 months (P=0.02).
  • Baseline myocardial strain, interstitial fibrosis, replacement fibrosis, and right ventricular contractile reserve did not predict LV reverse remodelling.
  • Men were more likely to experience adverse LV remodelling (P=0.01), while age and heart failure medications did not predict follow-up LVEF.

Conclusions:

  • Most patients with recent-onset DCM experience substantial LV function recovery within 12 months, with women showing the greatest improvement.
  • Low LV contractile reserve, as measured by dobutamine stress CMR, identifies patients with a lower likelihood of LVEF recovery.
  • LV contractile reserve emerges as a key biomarker for predicting functional recovery in DCM.
Abstract

Keywords:
Dilated cardiomyopathyDobutamine stressMyocardial remodellingRecovery

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