In Non-Ischemic Cardiomyopathy (NICMP), the Presence of LV Scar Detected by Delayed Enhancement-CMR Is a Stronger Predictor of Cardiovascular Events Than Left Ventricular Ejection Fraction (LVEF)

Abstract

LVEF has shown to be a strong predictor of cardiovascular events in patients with NICMP. CMR is a robust technique for LVEF assessment and detection of myocardial scar. We aimed to evaluate if myocardial scarring in NICMP could be a predictor of cardiovascular events. 140 patients that underwent CMR from 2009-2011 were enrolled. Inclusion criteria were absence of coronary artery disease, diagnosis of cardiomyopathy and ejection fraction < 45%. The patients with diagnosis of infiltrative disorders, hypertrophic cardiomyopathy, tachycardia induced cardiomyopathy or incomplete data were excluded. A total of 86 patients’ charts were reviewed and analyzed. Primary outcome was combination of hospitalization for heart failure, LVAD implantation, transplant or death. Adjusted Kaplan-Meier curves were constructed for groups with and without scar by CMR with significant p<0.05. Multivariate logistic regression analysis was performed. Patient demographics are shown. Baseline demographics were similar between groups. Adjusted event-free survival rate was significantly lower for patients with scar compared to those without scar by CMR at 2-years. Mean scar burden was 6% ± 8. On the analysis, presence of scar was an independent predictor of events, HR 4.35 (CI:1.31-14.4, p=0.017), but LVEF was not. In NICMP, the presence of LV scar measured by DE-CMR is a stronger predictor of cardiovascular events than LVEF. Further large multi-center studies should be performed to define the importance of scar by CMR in these patients.Fig. 1Demonstrates adjusted Event-Free survival in Patients with and without scar by CMRView Large Image Figure ViewerDownload Hi-res image Download (PPT)