Is there a role for diastolic function assessment in era of delayed enhancement cardiac magnetic resonance imaging? A multimodality imaging study in patients with advanced ischemic cardiomyopathy

João L. Cavalcante, Thomas H. Marwick, Rory Hachamovitch, Zoran B. Popovic, Nael Aldweib, Randall C. Starling, Milind Y. Desai, Scott D. Flamm, Deborah H. Kwon

Research output: Contribution to journalArticle

Abstract

Background Cardiac magnetic resonance (CMR) identifies important prognostic variables in ischemic cardiomyopathy (ICM) patients such as left ventricular (LV) volumes, LV ejection fraction (LVEF), peri-infarct zone, and myocardial scar burden (MSB). It is unknown whether Doppler-based diastolic dysfunction (DDF) retains its prognostic value in ICM patients, in the context of current imaging, medical, and device therapies. Methods Diastolic function was evaluated in ICM patients (LVEF 40% and ≥70% stenosis in ≥1 coronary artery) who underwent transthoracic echocardiogram and delayed hyperenhancement CMR studies within 7 days. The association of DDF with the combined end point was assessed after risk-adjustment using Cox proportional hazards models. Results A total of 360 patients with severe LV dysfunction (LVEF = 249%) and extensive MSB (3117%) were evaluated; DDF was present in all patients (stage 1%-44%, stage 2%-25%, stage 3%-31%). There were 130 events (124 deaths and 6 heart transplants) over a median follow-up of 5.8 years (IQR, 3.7-7.4 years). On multivariable analysis, DDF stage 1 (HR, 1.37; P =.007) was associated with the combined end-point, independent of clinical risk score (HR, 2.40; P 0001), implantable cardioverter defibrillator implantation (HR, 0.60; P =.009), incomplete revascularization (HR, 1.32; P =.003), mitral regurgitation (HR, 3.37; P =.01), peri-infarct zone area (HR, 1.04; P = 0.02), and MSB (HR, 1.02; P =.01). DDF had incremental prognostic value for the combined end-point (model χ;bsupesupincreased from 89 to 95, P =.02). Conclusion DDF is a powerful predictor of mortality in ICM patients with significant LV dysfunction, independent of clinical and CMR data. DDF assessment provides incremental value, improving risk stratification.

Original languageEnglish (US)
JournalAmerican Heart Journal
Volume168
Issue number2
DOIs
StatePublished - 2014
Externally publishedYes

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Cardiomyopathies
Magnetic Resonance Imaging
Cicatrix
Magnetic Resonance Spectroscopy
Left Ventricular Dysfunction
Risk Adjustment
Implantable Defibrillators
Mitral Valve Insufficiency
Proportional Hazards Models
Stroke Volume
Coronary Vessels
Pathologic Constriction
Myocardial Infarction
Transplants
Equipment and Supplies
Mortality

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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Is there a role for diastolic function assessment in era of delayed enhancement cardiac magnetic resonance imaging? A multimodality imaging study in patients with advanced ischemic cardiomyopathy. / Cavalcante, João L.; Marwick, Thomas H.; Hachamovitch, Rory; Popovic, Zoran B.; Aldweib, Nael; Starling, Randall C.; Desai, Milind Y.; Flamm, Scott D.; Kwon, Deborah H.

In: American Heart Journal, Vol. 168, No. 2, 2014.

Research output: Contribution to journalArticle

Cavalcante, João L. ; Marwick, Thomas H. ; Hachamovitch, Rory ; Popovic, Zoran B. ; Aldweib, Nael ; Starling, Randall C. ; Desai, Milind Y. ; Flamm, Scott D. ; Kwon, Deborah H. / Is there a role for diastolic function assessment in era of delayed enhancement cardiac magnetic resonance imaging? A multimodality imaging study in patients with advanced ischemic cardiomyopathy. In: American Heart Journal. 2014 ; Vol. 168, No. 2.
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title = "Is there a role for diastolic function assessment in era of delayed enhancement cardiac magnetic resonance imaging? A multimodality imaging study in patients with advanced ischemic cardiomyopathy",
abstract = "Background Cardiac magnetic resonance (CMR) identifies important prognostic variables in ischemic cardiomyopathy (ICM) patients such as left ventricular (LV) volumes, LV ejection fraction (LVEF), peri-infarct zone, and myocardial scar burden (MSB). It is unknown whether Doppler-based diastolic dysfunction (DDF) retains its prognostic value in ICM patients, in the context of current imaging, medical, and device therapies. Methods Diastolic function was evaluated in ICM patients (LVEF 40{\%} and ≥70{\%} stenosis in ≥1 coronary artery) who underwent transthoracic echocardiogram and delayed hyperenhancement CMR studies within 7 days. The association of DDF with the combined end point was assessed after risk-adjustment using Cox proportional hazards models. Results A total of 360 patients with severe LV dysfunction (LVEF = 249{\%}) and extensive MSB (3117{\%}) were evaluated; DDF was present in all patients (stage 1{\%}-44{\%}, stage 2{\%}-25{\%}, stage 3{\%}-31{\%}). There were 130 events (124 deaths and 6 heart transplants) over a median follow-up of 5.8 years (IQR, 3.7-7.4 years). On multivariable analysis, DDF stage 1 (HR, 1.37; P =.007) was associated with the combined end-point, independent of clinical risk score (HR, 2.40; P 0001), implantable cardioverter defibrillator implantation (HR, 0.60; P =.009), incomplete revascularization (HR, 1.32; P =.003), mitral regurgitation (HR, 3.37; P =.01), peri-infarct zone area (HR, 1.04; P = 0.02), and MSB (HR, 1.02; P =.01). DDF had incremental prognostic value for the combined end-point (model χ;bsupesupincreased from 89 to 95, P =.02). Conclusion DDF is a powerful predictor of mortality in ICM patients with significant LV dysfunction, independent of clinical and CMR data. DDF assessment provides incremental value, improving risk stratification.",
author = "Cavalcante, {Jo{\~a}o L.} and Marwick, {Thomas H.} and Rory Hachamovitch and Popovic, {Zoran B.} and Nael Aldweib and Starling, {Randall C.} and Desai, {Milind Y.} and Flamm, {Scott D.} and Kwon, {Deborah H.}",
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T1 - Is there a role for diastolic function assessment in era of delayed enhancement cardiac magnetic resonance imaging? A multimodality imaging study in patients with advanced ischemic cardiomyopathy

AU - Cavalcante, João L.

AU - Marwick, Thomas H.

AU - Hachamovitch, Rory

AU - Popovic, Zoran B.

AU - Aldweib, Nael

AU - Starling, Randall C.

AU - Desai, Milind Y.

AU - Flamm, Scott D.

AU - Kwon, Deborah H.

PY - 2014

Y1 - 2014

N2 - Background Cardiac magnetic resonance (CMR) identifies important prognostic variables in ischemic cardiomyopathy (ICM) patients such as left ventricular (LV) volumes, LV ejection fraction (LVEF), peri-infarct zone, and myocardial scar burden (MSB). It is unknown whether Doppler-based diastolic dysfunction (DDF) retains its prognostic value in ICM patients, in the context of current imaging, medical, and device therapies. Methods Diastolic function was evaluated in ICM patients (LVEF 40% and ≥70% stenosis in ≥1 coronary artery) who underwent transthoracic echocardiogram and delayed hyperenhancement CMR studies within 7 days. The association of DDF with the combined end point was assessed after risk-adjustment using Cox proportional hazards models. Results A total of 360 patients with severe LV dysfunction (LVEF = 249%) and extensive MSB (3117%) were evaluated; DDF was present in all patients (stage 1%-44%, stage 2%-25%, stage 3%-31%). There were 130 events (124 deaths and 6 heart transplants) over a median follow-up of 5.8 years (IQR, 3.7-7.4 years). On multivariable analysis, DDF stage 1 (HR, 1.37; P =.007) was associated with the combined end-point, independent of clinical risk score (HR, 2.40; P 0001), implantable cardioverter defibrillator implantation (HR, 0.60; P =.009), incomplete revascularization (HR, 1.32; P =.003), mitral regurgitation (HR, 3.37; P =.01), peri-infarct zone area (HR, 1.04; P = 0.02), and MSB (HR, 1.02; P =.01). DDF had incremental prognostic value for the combined end-point (model χ;bsupesupincreased from 89 to 95, P =.02). Conclusion DDF is a powerful predictor of mortality in ICM patients with significant LV dysfunction, independent of clinical and CMR data. DDF assessment provides incremental value, improving risk stratification.

AB - Background Cardiac magnetic resonance (CMR) identifies important prognostic variables in ischemic cardiomyopathy (ICM) patients such as left ventricular (LV) volumes, LV ejection fraction (LVEF), peri-infarct zone, and myocardial scar burden (MSB). It is unknown whether Doppler-based diastolic dysfunction (DDF) retains its prognostic value in ICM patients, in the context of current imaging, medical, and device therapies. Methods Diastolic function was evaluated in ICM patients (LVEF 40% and ≥70% stenosis in ≥1 coronary artery) who underwent transthoracic echocardiogram and delayed hyperenhancement CMR studies within 7 days. The association of DDF with the combined end point was assessed after risk-adjustment using Cox proportional hazards models. Results A total of 360 patients with severe LV dysfunction (LVEF = 249%) and extensive MSB (3117%) were evaluated; DDF was present in all patients (stage 1%-44%, stage 2%-25%, stage 3%-31%). There were 130 events (124 deaths and 6 heart transplants) over a median follow-up of 5.8 years (IQR, 3.7-7.4 years). On multivariable analysis, DDF stage 1 (HR, 1.37; P =.007) was associated with the combined end-point, independent of clinical risk score (HR, 2.40; P 0001), implantable cardioverter defibrillator implantation (HR, 0.60; P =.009), incomplete revascularization (HR, 1.32; P =.003), mitral regurgitation (HR, 3.37; P =.01), peri-infarct zone area (HR, 1.04; P = 0.02), and MSB (HR, 1.02; P =.01). DDF had incremental prognostic value for the combined end-point (model χ;bsupesupincreased from 89 to 95, P =.02). Conclusion DDF is a powerful predictor of mortality in ICM patients with significant LV dysfunction, independent of clinical and CMR data. DDF assessment provides incremental value, improving risk stratification.

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