The impact of mid-wall striate of LGE at interventricular septum to the beta-broker (Carvedilol) titrating to the target dose and the improvement of cardiac function with DCM

Introduction

It was reported that mid-wall striate late gadolinium enhancement at interventricular septum (MWS-LGE) definite by CMR was strong predictor of prognosis including sudden death with dilated cardiomyopathy (DCM). On the other hand, randomized trial have shown that beta-brokers lead symptomatic improvement, reduced hospitalization and enhanced survival in many patients with heart failure.

Purpose

The object of this study was to evaluate the impact of mid-wall striate of LGE(MWS-LGE) at interventricular septum to beta-broker (Carvedilol) titrating to the target dose and improvement of cardiac function with DCM.

Methods

Fifty-five patients with DCM examined by LGE-CMR were enrolled. They were treated with Carvedilol at higher dose as possible.

They were divided into two groups according to MWS-LGE positive or not.

The maximum dose of Carvedilol with each group at chronic stable condition(after 21.6 +/- 21.4 months later from initiation of Carvedilol) were compared. The improvement of UCG parameter of each group by Carvedilol therapy was examined.

Results

1) The UCG parameters of all 55 DCM patients recorded just before initiation of Carvedilol were LVDd; 65.2±7.5mm,LVDs; 56.3±8.5mm,EF;28.2.±8.1% and mean final dose of Carvedilol with all 55 DCM patients was 11.5±5.5mg.

2) MWS-LGE was found in twenty patients of DCM (38.1%) with LGE-CMR.

3) There were no significant difference between two groups in LVDd, LVDs and EF(P>0.79,P>0.92,P>0.76, respectively)at first echocardiograph.

4) The final dose of carvedilol with MWS-LGE -positive group was lower than with MWS-LGE -negative group (9.2+/-5.4 mg VS 13.0 +/-5.1mg, respectively).

5) The UCG parameter showed improvement at chronic stable phase compared to those had recorded at just before initiation of Carvedilol in the both groups, but especially in the MWS-LGE negative group showed a greater improvement than those of MWS-LGE positive group (Table 1).

Table 1 The UCG parameters at chronic stable phase

Conclusions

The relationship between the beneficial effect of Carvedilol with DCM and MWS-LGE defined by LGE-MRI was examined. The DCM patients with MWS-LGE negative showed higher maximum dose of Carvedilol and greater improvement of UCG parameters compared to those of patients with MWS-LGE positive. The MWS-LGE has a potential to have a strong worse impact to titrating and beneficial effect of Carvedilol with DCM.