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Predictors of left ventricular remodelling in patients with dilated cardiomyopathy - a cardiovascular magnetic resonance study

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Title: Predictors of left ventricular remodelling in patients with dilated cardiomyopathy - a cardiovascular magnetic resonance study
Authors: Tayal, U
Wage, R
Newsome, S
Manivarmane, R
Izgi, C
Muthumala, A
Dungu, JN
Assomull, R
Hatipoglu, S
Halliday, BP
Lota, AS
Ware, JS
Gregson, J
Frenneaux, M
Cook, SA
Pennell, DJ
Scott, AD
Cleland, JGF
Prasad, SK
Item Type: Journal Article
Abstract: Aims There is an important need for better biomarkers to predict left ventricular (LV) remodelling in dilated cardiomyopathy (DCM). We undertook a comprehensive assessment of cardiac structure and myocardial composition to determine predictors of remodelling. Methods and results Prospective study of patients with recent‐onset DCM with cardiovascular magnetic resonance (CMR) assessment of ventricular structure and function, extracellular volume (T1 mapping), myocardial strain, myocardial scar (late gadolinium enhancement) and contractile reserve (dobutamine stress). Regression analyses were used to evaluate predictors of change in LV ejection fraction (LVEF) over 12 months. We evaluated 56 participants (34 DCM patients, median LVEF 43%; 22 controls). Absolute LV contractile reserve predicted change in LVEF (1% increase associated with 0.4% increase in LVEF at 12 months, P = 0.02). Baseline myocardial strain (P = 0.39 global longitudinal strain), interstitial myocardial fibrosis (P = 0.41), replacement myocardial fibrosis (P = 0.25), and right ventricular contractile reserve (P = 0.17) were not associated with LV reverse remodelling. There was a poor correlation between contractile reserve and either LV extracellular volume fraction (r = −0.22, P = 0.23) or baseline LVEF (r = 0.07, P = 0.62). Men were more likely to experience adverse LV remodelling (P = 0.01) but age (P = 0.88) and disease‐modifying heart failure medication (beta‐blocker, P = 0.28; angiotensin‐converting enzyme inhibitor, P = 0.92) did not predict follow‐up LVEF. Conclusions Substantial recovery of LV function occurs within 12 months in most patients with recent‐onset DCM. Women had the greatest improvement in LVEF. A low LV contractile reserve measured by dobutamine stress CMR appears to identify patients whose LVEF is less likely to recover.
Issue Date: 1-Jul-2020
Date of Acceptance: 29-Nov-2019
URI: http://hdl.handle.net/10044/1/77060
DOI: 10.1002/ejhf.1734
ISSN: 1388-9842
Publisher: Wiley
Start Page: 1160
End Page: 1170
Journal / Book Title: European Journal of Heart Failure
Volume: 22
Issue: 7
Copyright Statement: © 2020 The Authors. European Journal of Heart Failure © 2020 European Society of Cardiology. This is the accepted version of the following article: Tayal, U., Wage, R., Newsome, S., Manivarmane, R., Izgi, C., Muthumala, A., Dungu, J.N., Assomull, R., Hatipoglu, S., Halliday, B.P., Lota, A.S., Ware, J.S., Gregson, J., Frenneaux, M., Cook, S.A., Pennell, D.J., Scott, A.D., Cleland, J.G. and Prasad, S.K. (2020), Predictors of left ventricular remodelling in patients with dilated cardiomyopathy – a cardiovascular magnetic resonance study. Eur J Heart Fail, which has been published in final form at https://doi.org/10.1002/ejhf.1734
Sponsor/Funder: Wellcome Trust
British Heart Foundation
Medical Research Council (MRC)
Funder's Grant Number: 107469/Z/15/Z
SP/17/11/32885
MR/M003191/1
Keywords: Science & Technology
Life Sciences & Biomedicine
Cardiac & Cardiovascular Systems
Cardiovascular System & Cardiology
Dilated cardiomyopathy
Myocardial remodelling
Recovery
Dobutamine stress
MYOCARDIAL CONTRACTILE RESERVE
DOBUTAMINE STRESS ECHOCARDIOGRAPHY
SYSTOLIC HEART-FAILURE
PROGNOSTIC-SIGNIFICANCE
EJECTION FRACTION
CARDIAC-FUNCTION
BETA-BLOCKADE
IMPROVEMENT
PREVALENCE
ASSOCIATION
Dilated cardiomyopathy
Dobutamine stress
Myocardial remodelling
Recovery
Science & Technology
Life Sciences & Biomedicine
Cardiac & Cardiovascular Systems
Cardiovascular System & Cardiology
Dilated cardiomyopathy
Myocardial remodelling
Recovery
Dobutamine stress
MYOCARDIAL CONTRACTILE RESERVE
DOBUTAMINE STRESS ECHOCARDIOGRAPHY
SYSTOLIC HEART-FAILURE
PROGNOSTIC-SIGNIFICANCE
EJECTION FRACTION
CARDIAC-FUNCTION
BETA-BLOCKADE
IMPROVEMENT
PREVALENCE
ASSOCIATION
1102 Cardiorespiratory Medicine and Haematology
Cardiovascular System & Hematology
Publication Status: Published
Online Publication Date: 2020-02-13
Appears in Collections:National Heart and Lung Institute
Institute of Clinical Sciences
Faculty of Medicine