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Is there a role for diastolic function assessment in era of delayed enhancement cardiac magnetic resonance imaging? A multimodality imaging study in patients with advanced ischemic cardiomyopathy
journal contribution
posted on 2023-05-18, 02:23 authored by Cavalcante, JL, Thomas MarwickThomas Marwick, Hachamovitch, R, Popovic, ZB, Aldweib, N, Starling, RC, Desai, MY, Flamm, SD, Kwon, DCardiac magnetic resonance (CMR) identifies important prognostic variables in ischemic cardiomyopathy (ICM) patients such as left ventricular (LV) volumes, LV ejection fraction (LVEF), peri-infarct zone, and myocardial scar burden (MSB). It is unknown whether Doppler-based diastolic dysfunction (DDF) retains its prognostic value in ICM patients, in the context of current imaging, medical, and device therapies. Methods: Diastolic function was evaluated in ICM patients (LVEF ≤40% and ≥70% stenosis in ≥1 coronary artery) who underwent transthoracic echocardiogram and delayed hyperenhancement CMR studies within 7 days. The association of DDF with the combined end point was assessed after risk-adjustment using Cox proportional hazards models. Results: A total of 360 patients with severe LV dysfunction (LVEF = 24±9%) and extensive MSB (31±17%) were evaluated; DDF was present in all patients (stage 1%-44%, stage 2%-25%, stage 3%-31%). There were 130 events (124 deaths and 6 heart transplants) over a median follow-up of 5.8 years (IQR, 3.7-7.4 years). On multivariable analysis, DDF > stage 1 (HR, 1.37; P = .007) was associated with the combined end-point, independent of clinical risk score (HR, 2.40; P < .0001), implantable cardioverter defibrillator implantation (HR, 0.60; P = .009), incomplete revascularization (HR, 1.32; P = .003), mitral regurgitation (HR, 3.37; P = .01), peri-infarct zone area (HR, 1.04; P = 0.02), and MSB (HR, 1.02; P = .01). DDF had incremental prognostic value for the combined end-point (model χ 2 increased from 89 to 95, P = .02). Conclusion: DDF is a powerful predictor of mortality in ICM patients with significant LV dysfunction, independent of clinical and CMR data. DDF assessment provides incremental value, improving risk stratification. © 2014 Mosby, Inc. All rights reserved.
History
Publication title
American Heart JournalVolume
168Pagination
220-228.e1ISSN
0002-8703Department/School
Menzies Institute for Medical ResearchPublisher
MosbyPlace of publication
Inc, 11830 Westline Industrial Dr, St Louis, USA, Mo, 63146-3318Rights statement
Copyright 2014 Mosby, IncRepository Status
- Restricted