Prediction of adverse outcomes in nonischemic dilated cardiomyopathy: A CMR-based nomogram

Abstract

ObjectivesTo develop and validate a novel nomogram score to predict outcomes in patients with nonischemic dilated cardiomyopathy (NIDCM) over a long follow-up period. MethodsA total of 335 consecutive NIDCM patients who underwent cardiac magnetic resonance (CMR) imaging were retrospectively enrolled. Comprehensive clinical evaluation and imaging investigation were obtained, including measurements of late gadolinium enhancement (LGE) and feature tracking (FT) images. All patients were followed up for a composite endpoint of major adverse cardiac events (MACE) including all-cause mortality and heart transplantation. These patients were randomly divided into development and validation cohorts (7:3). ResultsMACE occurred in 87 (37.2%) out of 234 patients in the development cohort, and in 31 (30.7%) out of 101 patients in the validation cohort. Five variables including NYHA class III-IV, NT-proBNP, beta-blocker medication, LGE presence, and LV global longitudinal strain (GLS) were found to be significantly associated with MACE and were used for constructing the nomogram. The nomogram achieved good discrimination with C-indexes in development and validation cohorts respectively. The calibration curve for 1-, 3-, and 5-year survival probability also showed high coherence between the predicted and actual probability of MACE. Decision curve analysis identified the model was significantly better net benefit in predicting MACE. ConclusionA novel nomogram score of a predictive model that incorporates clinical factors and imaging features was constructed, which could be conveniently used to facilitate risk evaluation in patients with NIDCM.