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

被引：39

作者：

Tayal, Upasana ^{[1
,2
]}

Wage, Ricardo ^{[2
]}

Newsome, Simon ^{[3
]}

Manivarmane, Ramasamy ^{[4
]}

Izgi, Cemil ^{[2
]}

Muthumala, Amal ^{[5
,6
]}

Dungu, Jason N. ^{[7
]}

Assomull, Ravi ^{[8
]}

Hatipoglu, Suzan ^{[1
,2
]}

Halliday, Brian P. ^{[1
,2
]}

Lota, Amrit S. ^{[1
,2
]}

Ware, James S. ^{[1
,2
,9
]}

Gregson, John ^{[3
]}

Frenneaux, Michael ^{[1
,10
]}

Cook, Stuart A. ^{[11
]}

Pennell, Dudley J. ^{[1
,2
]}

Scott, Andrew D. ^{[1
,2
]}

Cleland, John G. F. ^{[1
,2
]}

Prasad, Sanjay K. ^{[1
,2
]}

机构：

[1] Imperial Coll London, Natl Heart Lung Inst, London, England

[2] Royal Brompton Hosp, Cardiovasc Magnet Resonance Unit, London, England

[3] London Sch Hyg & Trop Med, Dept Med Stat, London, England

[4] Royal Brompton Hosp, Dept Echocardiog, London, England

[5] North Middlesex Univ Hosp, London, England

[6] St Bartholomews Hosp, London, England

[7] Essex Cardiothorac Ctr, Basildon, England

[8] Imperial Coll NHS Trust, London, England

[9] MRC London Inst Med Sci, London, England

[10] Univ East Anglia, Norwich, Norfolk, England

[11] Duke Natl Univ Singapore, Singapore, Singapore

来源：

EUROPEAN JOURNAL OF HEART FAILURE | 2020年 / 22卷 / 07期

基金：

英国惠康基金; 英国医学研究理事会;

关键词：

Dilated cardiomyopathy; Myocardial remodelling; Recovery; Dobutamine stress; MYOCARDIAL CONTRACTILE RESERVE; DOBUTAMINE STRESS ECHOCARDIOGRAPHY; SYSTOLIC HEART-FAILURE; PROGNOSTIC-SIGNIFICANCE; EJECTION FRACTION; CARDIAC-FUNCTION; BETA-BLOCKADE; IMPROVEMENT; PREVALENCE; ASSOCIATION;

D O I：

10.1002/ejhf.1734

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Aims There is an important need for better biomarkers to predict left ventricular (LV) remodelling in dilated cardiomyopathy (DCM). We undertook a comprehensive assessment of cardiac structure and myocardial composition to determine predictors of remodelling. Methods and results Prospective study of patients with recent-onset DCM with cardiovascular magnetic resonance (CMR) assessment of ventricular structure and function, extracellular volume (T1 mapping), myocardial strain, myocardial scar (late gadolinium enhancement) and contractile reserve (dobutamine stress). Regression analyses were used to evaluate predictors of change in LV ejection fraction (LVEF) over 12 months. We evaluated 56 participants (34 DCM patients, median LVEF 43%; 22 controls). Absolute LV contractile reserve predicted change in LVEF (1% increase associated with 0.4% increase in LVEF at 12 months, P = 0.02). Baseline myocardial strain (P = 0.39 global longitudinal strain), interstitial myocardial fibrosis (P = 0.41), replacement myocardial fibrosis (P = 0.25), and right ventricular contractile reserve (P = 0.17) were not associated with LV reverse remodelling. There was a poor correlation between contractile reserve and either LV extracellular volume fraction (r = -0.22, P = 0.23) or baseline LVEF (r = 0.07, P = 0.62). Men were more likely to experience adverse LV remodelling (P = 0.01) but age (P = 0.88) and disease-modifying heart failure medication (beta-blocker, P = 0.28; angiotensin-converting enzyme inhibitor, P = 0.92) did not predict follow-up LVEF. Conclusions Substantial recovery of LV function occurs within 12 months in most patients with recent-onset DCM. Women had the greatest improvement in LVEF. A low LV contractile reserve measured by dobutamine stress CMR appears to identify patients whose LVEF is less likely to recover.

引用

页码：1160 / 1170

页数：11

共 47 条

[1] Abnormal Global Longitudinal Strain Predicts Future Deterioration of Left Ventricular Function in Heart Failure Patients With a Recovered Left Ventricular Ejection Fraction [J].