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Author Notes:

Erik B. Schelbert, MD, MS, University of Pittsburgh School of Medicine, 200 Lothrop Street, PUH A349, Pittsburgh, PA 15213. E-mail: schelberteb@upmc.edu

We gratefully acknowledge and appreciate the support of Drs Christopher R. Deible, Joan M. Lacomis, and Ferenc Czeyda-Pommersheim from the Department of Radiology, and also Kathy Puntil, Deborah Yasko, Amritha Chandy, and Elizabeth Ruhl.

We thank the patients at the University of Pittsburgh Medical Center who volunteered to participate in this research.

Disclosures: None.

Subjects:

Research Funding:

Dr Schelbert is supported by a grant from The Pittsburgh Foundation, Grant M2009-0068, and an American Heart Association Scientist Development grant (09SDG2180083) including a T. Franklin Williams Scholarship Award; funding provided by: Atlantic Philanthropies, Inc, the John A. Hartford Foundation, the Association of Specialty Professors, and the American Heart Association.

Dr Wong is supported by grant K12 HS19461-01 from the Agency for Healthcare Research and Quality.

Dr Moon is supported by the UK National Institute for Health Research University College London Hospitals Biomedical Research Centre.

This work was also supported by grant UL1 RR024153 from the National Center for Research Resources (NCRR), a component of the National Institutes of Health (NIH), NIH Roadmap for Medical Research.

Keywords:

  • Science & Technology
  • Life Sciences & Biomedicine
  • Cardiac & Cardiovascular Systems
  • Cardiovascular System & Cardiology
  • late gadolinium enhancement
  • magnetic resonance imaging
  • myocardial delayed enhancement
  • myocardial fibrosis
  • myocardial infarction
  • DILATED CARDIOMYOPATHY
  • EJECTION FRACTION
  • RISK PREDICTION
  • CONTRAST
  • OUTCOMES
  • QUANTIFICATION
  • MULTICENTER
  • PERFORMANCE
  • DYSFUNCTION
  • PREVALENCE

Myocardial Damage Detected by Late Gadolinium Enhancement Cardiovascular Magnetic Resonance Is Associated With Subsequent Hospitalization for Heart Failure

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Journal Title:

Journal of the American Heart Association

Volume:

Volume 2, Number 6

Publisher:

, Pages e000416-e000416

Type of Work:

Article | Final Publisher PDF

Abstract:

BACKGROUND: Hospitalization for heart failure (HHF) is among the most important problems confronting medicine. Late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR) robustly identifies intrinsic myocardial damage. LGE may indicate inherent vulnerability to HHF, regardless of etiology, across the spectrum of heart failure stage or left ventricular ejection fraction (LVEF). METHODS AND RESULTS: We enrolled 1068 consecutive patients referred for CMR where 448 (42%) exhibited LGE. After a median of 1.4 years (Q1 to Q3: 0.9 to 2.0 years), 57 HHF events occurred, 15 deaths followed HHF, and 43 deaths occurred without antecedent HHF (58 total deaths). Using multivariable Cox regression adjusting for LVEF, heart failure stage, and other covariates, LGE was associated with first HHF after CMR (HR: 2.70, 95% CI: 1.32 to 5.50), death (HR: 2.13, 95% CI: 1.08 to 4.21), or either death or HHF (HR: 2.52, 95% CI: 1.49 to 4.25). Quantifying LGE extent yielded similar results; more LGE equated higher risks. LGE improved model discrimination (IDI: 0.016, 95% CI: 0.005 to 0.028, P=0.002) and reclassification of individuals at risk (continuous NRI: 0.40, 95% CI: 0.05 to 0.70, P=0.024). Adjustment for competing risks of death that shares common risk factors with HHF strengthened the LGE and HHF association (HR: 4.85, 95% CI: 1.40 to 16.9). CONCLUSIONS: The presence and extent of LGE is associated with vulnerability for HHF, including higher risks of HHF across the spectrum of heart failure stage and LVEF. Even when LVEF is severely decreased, those without LGE appear to fare reasonably well. LGE may enhance risk stratification for HHF and may enhance both clinical and research efforts to reduce HHF through targeted treatment.

Copyright information:

© 2013 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

This is an Open Access work distributed under the terms of the Creative Commons Attribution-Noncommercial 3.0 Unported License (http://creativecommons.org/licenses/by-nc/3.0/).

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