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Temporal progression of replacement and interstitial fibrosis in optimally managed dilated cardiomyopathy patients: A

Pawel Rubiś1, Paweł Banyś2, Maciej Krupiński2

  • 1Krakow Specialist Hospital named after St. John Paul II, Pradnicka street 80, 31-202 Krakow, Poland; Department of Cardiac and Vascular Diseases, Jagiellonian University Medical College, Institute of Cardiology, Krakow Specialist Hospital named after St. John Paul II, Poland.

International Journal of Cardiology
|March 28, 2024
PubMed

Insights

In dilated cardiomyopathy (DCM) patients, cardiac fibrosis remained stable over one year, but left ventricular (LV) volumes decreased. The LV matrix volume index predicted patient outcomes.

Area of Science:

  • Cardiology
  • Cardiovascular Imaging
  • Fibrosis Research

Background:

  • Dilated cardiomyopathy (DCM) is characterized by progressive left ventricular (LV) dysfunction.
  • Understanding the dynamic evolution of cardiac fibrosis in DCM is crucial for predicting patient outcomes.
  • Fibrotic processes, including replacement and interstitial fibrosis, contribute to myocardial stiffening and adverse remodeling.

Purpose of the Study:

  • To prospectively evaluate the one-year dynamic changes in replacement and interstitial fibrosis in patients with DCM.
  • To assess the relationship between fibrotic changes, left ventricular volumes, and clinical outcomes in DCM patients.
  • To identify predictors of adverse events in DCM patients based on cardiac imaging parameters.

Main Methods:

  • Prospective observational study involving 102 DCM patients.
  • Cardiac magnetic resonance (CMR) imaging including late gadolinium enhancement (LGE) for replacement fibrosis and T1-mapping for interstitial fibrosis (extracellular volume fraction - ECV).
  • Assessment of LV matrix and cellular volumes, with follow-up CMR after approximately 14 months and clinical outcome assessment.

Main Results:

  • Replacement fibrosis (LGE mass) remained stable, while LGE extent increased significantly (p < 0.01) over one year.
  • Interstitial fibrosis (ECV) showed no significant change.
  • Left ventricular matrix and cell volumes demonstrated significant regression.
  • LV matrix volume index at follow-up was an independent predictor of adverse clinical outcomes (all-cause mortality, heart transplantation, LVAD, or heart failure worsening).

Conclusions:

  • In optimally managed DCM patients, cardiac fibrosis (replacement and interstitial) is relatively stable within one year.
  • Significant regression of LV matrix and cell volumes occurs over one year in DCM patients.
  • The LV matrix volume index derived from CMR is a valuable independent predictor of long-term prognosis in DCM.
Abstract

Keywords:
Cardiac magnetic resonanceDilated cardiomyopathyFibrosisOutcome

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