Abstract 16938: Late Gadolinium Enhancement on Cardiac Magnetic Resonance as Predictor of Overall Mortality in Patients With Non-Ischemic Cardiomyopathy

Abstract

Background: Patients with heart failure due to non-ischemic cardiomyopathy (NICM) constitute a heterogenous group of patients with diverse prognosis. The presence of late gadolinium enhancement (LGE) by cardiac magnetic resonance imaging represents a measure of myocardial damage and can provide prognostic information. Objective: This study aimed to evaluate the prognostic role of the presence and pattern of LGE in patients with NICM . Methods: Using the NICM registry, we conducted a retrospective cohort study of adult patients with NICM, undergoing CMRI between 1999–2016. Using multivariable Cox regression model and Fine and Gray’s competing risk regression model, we evaluated the association between LGE presence and patterns with all-cause mortality, heart transplant, and ventricular assist device (VAD). We adjusted the model for clinically important covariates. Results: Our cohort of 1842 patients showed a mean age of 56 ± 14, 73% male sex, 30% NYHA class III-IV, 15% diabetic and 89% had idiopathic dilated cardiomyopathy. During a median follow-up of 2.3 years, we observed 215 composite outcome of all-cause mortality, transplant, or VAD. LGE was present in 56% of our cohort: 18% subendocardial, 18% mid-wall, 17% diffuse pattern, and 3% subepicardial. LGE was significantly associated with a 2-fold increased risk of events (HR 2.0, 95%CI 1.4-3.0) (figure). Of all LGE patterns, subendocardial, midwall, and diffuse LGE patterns were associated with the worst prognosis. (table). Conclusions: In patients with NICM, LGE in significantly associated with increased risk of death or need for advanced heart failure therapies. The use of CMR in patients with NICM provides both diagnostic and prognostic information.