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The Extent of Late Gadolinium Enhancement Can Predict Adverse Cardiac Outcomes in Patients with Non-Ischemic Cardiomyopathy with Reduced Left Ventricular Ejection Fraction: A Prospective Observational Study

Korean Journal of Radiology 2021년 22권 3호 p.324 ~ 333
김은경, 이가연, 장신이, 장성아, 김성목, 박성지, 최진오, 박성우, 최연현, 이상철, Oh Jae-K.,
소속 상세정보
김은경 ( Kim Eun-Kyoung ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Medicine
이가연 ( Lee Ga-Yeon ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Medicine
장신이 ( Jang Shin-Yi ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Medicine
장성아 ( Chang Sung-A ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Medicine
김성목 ( Kim Sung-Mok ) - Sungkyunkwan University School of Medicine Department of Radiology
박성지 ( Park Sung-Ji ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Medicine
최진오 ( Choi Jin-Oh ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Medicine
박성우 ( Park Seung-Woo ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Medicine
최연현 ( Choe Yeon-Hyeon ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Radiology
이상철 ( Lee Sang-Chol ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Medicine
 ( Oh Jae-K. ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Medicine

Abstract


Objective: The clinical course of an individual patient with heart failure is unpredictable with left ventricle ejection fraction (LVEF) only. We aimed to evaluate the prognostic value of cardiac magnetic resonance (CMR)-derived myocardial fibrosis extent and to determine the cutoff value for event-free survival in patients with non-ischemic cardiomyopathy (NICM) who had severely reduced LVEF.

Materials and Methods: Our prospective cohort study included 78 NICM patients with significantly reduced LV systolic function (LVEF < 35%). CMR images were analyzed for the presence and extent of late gadolinium enhancement (LGE). The primary outcome was major adverse cardiac events (MACEs), defined as a composite of cardiac death, heart transplantation, implantable cardioverter-defibrillator discharge for major arrhythmia, and hospitalization for congestive heart failure within 5 years after enrollment.

Results: A total of 80.8% (n = 63) of enrolled patients had LGE, with the median LVEF of 25.4% (19.8?32.4%). The extent of myocardial scarring was significantly higher in patients who experienced MACE than in those without any cardiac events (22.0 [5.5?46.1] %LV vs. 6.7 [0?17.1] %LV, respectively, p = 0.008). During follow-up, 51.4% of patients with LGE ≥ 12.0 %LV experienced MACE, along with 20.9% of those with LGE ≤ 12.0 %LV (log-rank p = 0.001). According to multivariate analysis, LGE extent more than 12.0 %LV was independently associated with MACE (adjusted hazard ratio, 6.71; 95% confidence interval, 2.54?17.74; p < 0.001).

Conclusion: In NICM patients with significantly reduced LV systolic function, the extent of LGE is a strong predictor for long-term adverse cardiac outcomes. Event-free survival was well discriminated with an LGE cutoff value of 12.0 %LV in these patients.

키워드

Non-ischemic cardiomyopathy; Late gadolinium enhancement; Cardiac outcomes

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