Late Gadolinium Enhancement Amount As an Independent Risk Factor for the Incidence of Adverse Cardiovascular Events in Patients with Stage C or D Heart Failure

Tong Liu; Xiaohai Ma; Wei Liu; Shukuan Ling; Lei Zhao; Lei Xu; Deli Song; Jie Liu; Zhonghua Sun; Zhanming Fan; Taiyang Luo; Junping Kang; Xiaohui Liu; Jianzeng Dong

doi:10.3389/fphys.2016.00484

Late Gadolinium Enhancement Amount As an Independent Risk Factor for the Incidence of Adverse Cardiovascular Events in Patients with Stage C or D Heart Failure

Front Physiol. 2016 Oct 28:7:484. doi: 10.3389/fphys.2016.00484. eCollection 2016.

Authors

Tong Liu¹, Xiaohai Ma², Wei Liu¹, Shukuan Ling³, Lei Zhao², Lei Xu², Deli Song¹, Jie Liu⁴, Zhonghua Sun⁵, Zhanming Fan², Taiyang Luo¹, Junping Kang¹, Xiaohui Liu¹, Jianzeng Dong¹

Affiliations

¹ Department of Cardiology, Capital Medical University, Beijing Anzhen Hospital Beijing, China.
² Department of Radiology, Capital Medical University, Beijing Anzhen Hospital Beijing, China.
³ State Key Lab of Space Medicine Fundamentals and Application, China Astronaut Research and Training Center Beijing, China.
⁴ Department of Vascular Surgery, Chinese PLA General Hospital Beijing, China.
⁵ Department of Medical Radiation Sciences, School of Science, Curtin University Perth, WA, Australia.

Abstract

Background: Myocardial fibrosis (MF) is a risk factor for poor prognosis in dilated cardiomyopathy (DCM). Late gadolinium enhancement (LGE) of the myocardium on cardiac magnetic resonance (CMR) represents MF. We examined whether the LGE amount increases the incidence of adverse cardiovascular events in patients with stage C or D heart failure (HF). Methods: Eighty-four consecutive patients with stage C or D HF, either ischemic or non-ischemic, were enrolled. Comprehensive clinical and CMR evaluations were performed. All patients were followed up for a composite endpoint of cardiovascular death, heart transplantation, and cardiac resynchronization therapy with defibrillator (CRT-D). Results: LGE was present in 79.7% of the end-stage HF patients. LGE distribution patterns were mid-wall, epi-myocardial, endo-myocardial, and the morphological patterns were patchy, transmural, and diffuse. During the average follow-up of 544 days, 13 (15.5%) patients had endpoint events: 7 patients cardiac death, 2 patients heart transplantation, and 4 patients underwent CRT-D implantation. On univariate analysis, LGE quantification on cardiac magnetic resonance, blood urine nitrogen, QRS duration on electrocardiogram, left ventricular end-diastolic diameter (LVEDD), and left ventricular end-diastolic volume (LVEDV) on CMR had the strongest associations with the composite endpoint events. However, on multivariate analysis for both Model I (after adjusting for age, sex, and body mass index) and Model II (after adjusting for age, sex, BMI, renal function, QRS duration, and atrial fibrillation on electrocardiogram, the etiology of HF, LVEF, CMR-LVEDD, and CMR-LVEDV), LGE amount was a significant risk factor for composite endpoint events (Model I 6SD HR 1.037, 95%CI 1.005-1.071, p = 0.022; Model II 6SD HR 1.045, 95%CI 1.001-1.084, p = 0.022). Conclusion: LGE amount from high-scale threshold on CMR increased the incidence of adverse cardiovascular events for patients in either stage C or D HF.

Keywords: adverse cardiovascular events; heart failure; late gadolinium enhancement; magnetic resonance imaging; prognosis.