Abstract 1978: Patterns of Late Gadolinium Enhancement are Associated with Ventricular Stiffness in Patients with Advanced Non-Ischemic Dilated Cardiomyopathy

Abstract

Background: In patients with advanced systolic heart failure, restriction of left ventricular (LV) filling or mechanical dyssynchrony rather than lower ejection fraction (EF) is more associated with poor prognosis. However, structural determinants of these parameters have not been fully studied. Objectives: We investigated whether patterns of late gadolinium enhancement (LGE) in cardiac magnetic resonance (CMR) affect the ventricular mechanics and fillings in patients with non-ischemic dilated cardiomyopathy (DCM). Methods: Patients with markedly reduced systolic function (LVEF <35%) due to longstanding (> 6 months) non-ischemic DCM underwent CMR after comprehensive echo-Doppler evaluations. Intraventricular synchrony index was measured by standard deviation of time to peak longitudinal contractions (Ts-SD) in 12 LV segments. Patients with significant aortic regurgitation or atrial fibrillation were excluded. Results: Patients (n=49) could be divided into three groups according to LGE patterns as non-LGE group (n=18), non-midwall LGE group (n=13) and midwall LGE group (n=18). There were no differences in clinical characteristics, LV dimension, LVEF and Ts-SD among three groups. However, in terms of LV longitudinal mechanics, midwall LGE group was associated with higher E/Em and lower Am and Sm. Moreover, diastolic LV stiffness index (Ed), defined as E/Em/stroke volume (ml), was significantly higher in midwall LGE group compared with non-LGE group (0.85±0.51 vs. 0.41±0.21, p=0.002), and non-midwall LGE group (0.85±0.51 vs. 0.46±0.31, p=0.008). Conclusions: Presence and patterns of LGE is associated with ventricular filling and stiffness in advanced non-ischemic dilated cardiomyopathy.