Time-dependent prognostic improvement by late gadolinium enhancement in dilated cardiomyopathy
Siqi Tang1, Yuanwei Xu2, Yangjie Li2
1Department of Internal Medicine, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China.
Insights
Adding late gadolinium enhancement (LGE) to heart failure (HF) prediction models moderately improves long-term mortality prediction in dilated cardiomyopathy (DCM) patients. Short-term prediction accuracy was not significantly enhanced by LGE integration.
Area of Science:
- Cardiology
- Medical Imaging
- Heart Failure Research
Background:
- Dilated cardiomyopathy (DCM) is a primary cause of heart failure (HF).
- Current HF prediction models lack specific validation in DCM cohorts.
- Late gadolinium enhancement (LGE) on cardiac magnetic resonance (CMR) is a known mortality predictor in DCM.
Purpose of the Study:
- To externally validate existing HF prediction models in a DCM cohort.
- To assess the incremental value of LGE in improving HF prediction accuracy in DCM patients.
Main Methods:
- Single-center cohort study of 524 hospitalized DCM patients undergoing CMR.
- External validation of five established HF models (SHFM, GISSI-HF, MAGGIC, BIOSTAT-CHF, PREDICT-HF).
- Development of LGE-enhanced models integrating LGE characteristics (presence, location, pattern) with existing risk scores.
Main Results:
- PREDICT-HF demonstrated the best discrimination among validated models (C-index 0.73).
- Incorporating LGE (presence, location, pattern) significantly improved discrimination for 3- and 4-year predictions (P<0.05).
- LGE integration did not enhance short-term (1- and 2-year) prediction accuracy.
Conclusions:
- Existing clinical variable-based HF models offer moderate prediction in DCM.
- LGE significantly enhances long-term mortality prediction in DCM patients.
- LGE does not improve short-term HF prediction efficacy in this cohort.
Background:
Dilated cardiomyopathy (DCM) represents a major cause of heart failure (HF), but current HF prediction models lack validation in DCM cohorts. Late gadolinium enhancement (LGE) predicts mortality in DCM patients. The incremental value of LGE to existing models warrants exploration.
Methods:
In this single-center cohort study, hospitalized patients with DCM who underwent cardiac magnetic resonance (CMR) between June 2012 and August 2020 were included. We externally validated five published HF models as follows: SHFM, GISSI-HF, MAGGIC, BIOSTAT-CHF, and PREDICT-HF. The composite endpoints were all-cause mortality and heart transplantation. We then developed three LGE-enhanced models by integrating LGE presence, location, and patterns with risk scores from the published models, respectively.
Results:
Of 524 DCM patients (age 48.7±15.1, 71% male), 154 patients (29.4%) reached the composite endpoint (median follow-up of 47.6 months). PREDICT-HF showed the best overall discrimination (Harrell's C index: 0.73, 95% CI: 0.69-0.77), similar to SHFM (0.71, 95% CI： 0.67-0.75), better than MAGGIC (0.68, 95% CI: 0.64-0.73), GISSI-HF (0.65, 95% CI: 0.60-0.70), and BIOSTAT-CHF (0.66, 95% CI: 0.61-0.71). Using time-dependent C index, incorporating LGE presence, location, or pattern improved overall discrimination in all LGE-enhanced models, and for 3- and 4-year predictions (all P<0.05), but not in 1- and 2-year predictions. LGE-enhanced models with LGE presence and location yielded similar findings.
Conclusion:
Existing HF models, primarily utilizing clinical variables, moderately predict outcomes in DCM. Adding LGE improves long-term mortality prediction accuracy but not short-term efficacy.
Registration:
URL: https://www.
Clinicaltrials:
gov; Unique identifier: ChiCTR1800017058.
More Related Videos
08:19Transthoracic Echocardiography to Assess Post-Resuscitation Left Ventricular Dysfunction After Acute Myocardial Infarction and Cardiac Arrest in Pigs
Published on: July 12, 2022
08:13In Vivo Quantitative Assessment of Myocardial Structure, Function, Perfusion and Viability Using Cardiac Micro-computed Tomography
Published on: February 16, 2016
Related Concept Videos
01:30Cardiomyopathy II: Dilated Cardiomyopathy
01:29Cardiomyopathy III: Hypertrophic Cardiomyopathy
01:29Cardiomyopathy V: Interprofessional Care