Objective criteria for septal fibrosis in non-ischemic dilated cardiomyopathy: validation for the prediction of future cardiovascular events

Autor: Andrew G Howarth, Raymond Yee, Mohammed Zahrani, Aidan Cornhill, Sebastien X Joncas, Fahad Almehmadi, Bobak Heydari, John Stirrat, Yoko Mikami, Carmen P Lydell, Mahmoud Bokhari, James A. White, Naeem Merchant
Rok vydání: 2016
Předmět:
Male
Time Factors
Dilated cardiomyopathy
Contrast Media
Kaplan-Meier Estimate
030204 cardiovascular system & hematology
030218 nuclear medicine & medical imaging
0302 clinical medicine
Fibrosis
Septal fibrosis
Heart Septum
Registries
Medicine(all)
Observer Variation
Ejection fraction
Radiological and Ultrasound Technology
medicine.diagnostic_test
Middle Aged
Prognosis
Defibrillators
Implantable
Cardiology
Disease Progression
Female
Non ischemic
Radiology
Clinical Competence
Cardiology and Cardiovascular Medicine
Cardiovascular outcomes
Adult
Cardiomyopathy
Dilated
medicine.medical_specialty
Electric Countershock
Magnetic Resonance Imaging
Cine
Disease-Free Survival
03 medical and health sciences
Predictive Value of Tests
Internal medicine
medicine
Organometallic Compounds
Humans
Radiology
Nuclear Medicine and imaging
cardiovascular diseases
Angiology
Aged
Proportional Hazards Models
business.industry
Research
Reproducibility of Results
Magnetic resonance imaging
medicine.disease
Feasibility Studies
Cardiovascular magnetic resonance
business
Zdroj: Journal of Cardiovascular Magnetic Resonance
ISSN: 1532-429X
Popis: Background Expert subjective reporting of mid-wall septal fibrosis on late gadolinium enhancement (LGE) images has been shown to predict major cardiovascular outcomes in patients with non-ischemic dilated cardiomyopathy (NIDCM). This study aims to establish objective criteria for non-experts to report clinically relevant septal fibrosis and compare its performance by such readers versus experts for the prediction of cardiovascular events. Methods LGE cardiovascular magnetic resonance (CMR) was performed in 118 consecutive patients with NIDCM (mean age 57 ± 14, 42 % female) and the presence of septal fibrosis scored by expert readers. CMR-naive readers performed signal threshold-based LGE quantification by referencing mean values of remote tissue and applying these to a pre-defined anatomic region to measure septal fibrosis. All patients were followed for the primary composite outcome of cardiac mortality or appropriate implantable cardioverter-defibrillator (ICD) therapy. Results The mean LVEF was 32 ± 12 %. At a median follow-up of 1.9 years, 20 patients (17 %) experienced a primary composite outcome. Expert visual scoring identified 55 patients with septal fibrosis. Non-expert septal fibrosis quantification was highly reproducible and identified mean septal fibrosis burden for three measured thresholds as follows; 5SD: 2.9 ± 3.6 %, 3SD: 6.9 ± 6.3 %, and 2SD: 11.1 ± 7.5 % of the left ventricular (LV) mass, respectively. By ROC analysis, optimal thresholds for prediction of the primary outcome were; 5SD: 2.74 % (HR 8.7, p 5SD threshold) was the strongest independent predictor of the primary outcome (HR 8.7) and provided improved risk reclassification beyond LVEF alone (NRI 0.54, 95 % CI 0.16–0.92, p = 0.005). Conclusions Novice readers were able to achieve superior risk prediction for future cardiovascular events versus experts using objective criteria for septal fibrosis in patients with NIDCM. Patients with a septal fibrosis burden >2.74 % of the LV mass (>5SD threshold) were at a 9-fold higher risk of cardiac death or appropriate ICD therapy versus those not meeting this criteria. As such, this study validates reproducible criteria applicable to all levels of expertise to identify NIDCM patients at high risk of future cardiovascular events.
Databáze: OpenAIRE
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