- Poster presentation
- Open Access
The decisive role of cardiovascular MRI delayed hyperenhancement (DHE) pattern for risk stratification for dilated cardiomyopathy
© Venero et al; licensee BioMed Central Ltd. 2009
- Published: 28 January 2009
- Dilate Cardiomyopathy
- NYHA Class
- Advanced Heart Failure
- Event Free Survival
- Improve Risk Stratification
Risk stratification in dilated cardiomyopathy (CMX) patients with advanced heart failure remains a growing clinical challenge. A simple manner to non-invasively risk stratify this difficult cohort would have obvious advantages.
Utilizing cardiovascular MRI (CMR), recently demonstrated to identify abnormal myocardial substrate, typically infarct or more recently infiltrative pathology via the delayed hyperenhancement technique (DHE), we hypothesize that +DHE will represent an adverse prognosis as defined by need for urgent cardiac transplantation (TX), LVAD or death in a dilated cardiomyopathy patients.
Over 24 consecutive months, 13 patients with a dilated CMX and NYHA class III-IV heart failure underwent standard 3D CMR (1.5 T GE, Excite, Milwaukee, WI) to interrogate the pattern, distribution and extent of DHE (MultiHance, Bracco Diagnostics, Princeton, N J, USA). Patients were categorized into: 1) + DHE/+midwall Stripe 2) +DHE/-midwall Stripe and 3) -DHE/-Stripe. LVAD, Tx need, major adverse clinical events (MACE) and event free survival were evaluated over the next 6 months.
No. of patients
CMX patients with advanced heart failure require an improved risk stratification policy. We believe this observation represents the first attempt to risk stratfiy systematically for those with a dilated CMX. Specifically, a simple observation of the binary nature of DHE/Stripe predicated early morbidity and mortality. Herein, using standard CMR, the presence of +DHE/+Stripe is highly predictive of LVAD and Tx need over the ensuing 6 months. Those +DHE/-Stripe patients have intermediate risk but no LVAD/Tx use, while those -DHE/-Stripe have a good prognosis. Thus, incorporating this approach into routine clinical practice may help manage CMX patients more expectantly and effectively.
This article is published under license to BioMed Central Ltd.