Association Between Left Ventricular Global Function Index and Outcomes in Patients With Dilated Cardiomyopathy.

Tong Liu,Guang Yang,Zhen Zhou,Sanshuai Chang,Yifeng Gao,Lei Xu,David Firmin,Kairui Bo,Hui Wang,Yuqing Sun,Wei Liu,Jianzeng Dong,Rui Wang,Yuanyuan Liu

doi:10.3389/fcvm.2021.751907

Abstract

Purpose: Left ventricular global function index (LVGFI) assessed using cardiac magnetic resonance (CMR) seems promising in the prediction of clinical outcomes. However, the role of the LVGFI is uncertain in patients with heart failure (HF) with dilated cardiomyopathy (DCM). To describe the association of LVGFI and outcomes in patients with DCM, it was hypothesized that LVGFI is associated with decreased major adverse cardiac events (MACEs) in patients with DCM.Materials and Methods: This prospective cohort study was conducted from January 2015 to April 2020 in consecutive patients with DCM who underwent CMR. The association between outcomes and LVGFI was assessed using a multivariable model adjusted with confounders. LVGFI was the primary exposure variable. The long-term outcome was a composite endpoint, including death or heart transplantation.Results: A total of 334 patients (mean age: 55 years) were included in this study. The average of CMR-LVGFI was 16.53%. Over a median follow-up of 565 days, 43 patients reached the composite endpoint. Kaplan–Meier analysis revealed that patients with LVGFI lower than the cutoff values (15.73%) had a higher estimated cumulative incidence of the endpoint compared to those with LVGFI higher than the cutoff values (P = 0.0021). The hazard of MACEs decreased by 38% for each 1 SD increase in LVGFI (hazard ratio 0.62[95%CI 0.43–0.91]) and after adjustment by 46% (HR 0.54 [95%CI 0.32–0.89]). The association was consistent across subgroup analyses.Conclusion: In this study, an increase in CMR-LVGFI was associated with decreasing the long-term risk of MACEs with DCM after adjustment for traditional confounders.

Highlights

The most common causes of heart failure (HF) include ischemia dilated cardiomyopathy (IDCM) and non-ischemia dilated cardiomyopathy (NIDCM) [1]
The hazard of major adverse cardiac events (MACEs) decreased by 38% for each 1 SD increase in Left ventricular global function index (LVGFI) and after adjustment by 46% (HR 0.54 [95%CI 0.32–0.89])
In this study, an increase in cardiac magnetic resonance (CMR)-LVGFI was associated with decreasing the long-term risk of MACEs with DCM after adjustment for traditional confounders

Summary

Introduction

The most common causes of heart failure (HF) include ischemia dilated cardiomyopathy (IDCM) and non-ischemia dilated cardiomyopathy (NIDCM) [1]. Both DCMs involve left ventricular (LV) dilation and contractile dysfunction, referring to cardiac remodeling underlying the morphological substrate of the clinical syndrome of HF, and are associated with adverse clinical outcomes in pathological conditions [2]. A previous observational study [3] showed eccentric hypertrophy, in which myocardial mass was increased with cavity enlargement in 94% of the patients with DCM. The increased LV mass is the same as the increased LV volume and depressed LV systolic function (ventricles exhibit eccentric hypertrophy), which is crucial for prognosis [4]. The comprehensive evaluation of cardiac performance requires a combination of the structure and function measurement

Methods

Results

Discussion

Conclusion