Myocardial Fibrosis Predicts Death in Dilated Cardiomyopathy
(HealthDay News) – For patients with dilated cardiomyopathy, myocardial fibrosis independently predicts all-cause mortality; and for patients with coronary artery disease and regional wall thinning, the extent of scarring is associated with contractile improvement and reversal of thinning, according to two studies published in the March 6 issue of the Journal of the American Medical Association.
Ankur Gulati, MD, from the Royal Brompton Hospital in London, and colleagues examined whether late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR) imaging-detected myocardial fibrosis independently predicted mortality in patients with dilated cardiomyopathy. The researchers found that 26.8% of 142 patients with midwall fibrosis and 10.6% of 330 patients without fibrosis died (hazard ratio, 2.96). The presence and extent of fibrosis were significantly independently associated with all-cause mortality (hazard ratio, 2.43 and 1.11, respectively), after adjustment for left ventricular ejection fraction and other conventional prognostic factors.
Dipan J. Shah, MD, from the Duke University Medical Center in Durham, NC, and colleagues determined scar burden and potential for functional improvement among patients with coronary artery disease with CMR-detected regional myocardial wall thinning. The researchers found that 19% of the 1,055 patients had regional wall thinning. The extent of scarring was 72% within these regions, and limited scar burden was seen in 18% of thinned regions. Lack of scarring was associated with contractile improvement and reverse remodeling.
"For the practicing physician, the incremental information gained from CMR with LGE imaging from these two studies, albeit novel and supportive, is not yet sufficient to alter clinical practice guidelines," write the authors of an accompanying editorial.
Authors from both studies disclosed financial ties to the pharmaceutical and biotechnology industries. Two authors from the Shah study are named inventors on a patent for delayed enhancement cardiovascular magnetic resonance imaging.