Abstract 12851: Prognostic Value Of Late Gadolinium Enhancement In Patients With Idiopathic Dilated Cardiomyopathy

Abstract

Introduction: The aim of this study was to investigate the association between the extent and pattern of late gadolinium enhancement (LGE) and outcomes in a large idiopathic dilated cardiomyopathy (DCM) cohort Hypothesis: LGE is associated with worse outcomes in patient with idiopathic dilated cardiomyopathy Methods: In this study, we retrospectively identified all patients with idiopathic DCM who underwent cardiac MRI (CMR) from 2015 to 2020 at a single large academic center. The association between the pattern of LGE and event free survival from transplantation and mechanical circulatory support was analyzed using Kaplan Meier analysis and the log-rank test. Results: Of a total of 286 patients (64% male, 62% Caucasian) with idiopathic DCM who underwent CMR, LGE was detected in 59 (21%) patients. Of the patients with LGE, 7 (3%) patients had free-wall LGE, 40 (14%) had septal LGE and 12 (4%) had both septal and free wall LGE. All patients had linear mid-wall LGE and two patients had both linear-mid wall and sub-epicardial involvement. The presence of septal LGE was associated with older age (58 ± 12 vs 47 ± 16 years, p<0.001), a lower LV ejection fraction (EF) (30% ± 12 vs 37% ± 12, p<0.001), higher LV end-diastolic volume index (146 ± 47 vs 126 ± 36 ml/m 2 , p<0.001), lower right ventricular EF (37% ± 13 vs 42% ± 13, p=0.013), higher LV mass index (82 ± 25 vs 73 ± 24 g/m 2 , p=0.013), higher incidence of LBBB (29% ± 16 vs 16% ± 29) and atrial fibrillation (31% vs 17%, p=0.021). Over a mean follow-up time of 26 ± 19 months, patients with septal LGE were less likely to experience event free survival from heart transplant or durable mechanical circulatory support (Figure 1, p=0.009). Conclusions: The presence of septal LGE in this large idiopathic DCM cohort is associated with worse outcomes. Additional research is needed to determine whether these findings will aid clinical management of these patients.