Clinical InvestigationImaging and Diagnostic TestingIs 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
Section snippets
Patient population and study design
We examined 459 consecutive patients with the diagnosis of ICM (LVEF ≤40% with ≥70% stenosis in ≥1 epicardial coronary vessel on angiography and/or history of MI or coronary revascularization,10) who were referred for clinically indicated myocardial viability assessment with CMR between January 2002 and December 2006. All transthoracic echocardiograms (TTE) obtained within a maximum of 7 days from the index CMR study were used for the analysis detailed below. Patients with standard CMR
Patient characteristics
Our study cohort (n = 360) was middle aged (62 ± 11 years) and predominantly male (76%) with a high prevalence of cardiovascular risk factors. A total of 43% had prior revascularization and majority received optimal medical therapies including β-blockers, angiotensin converting enzyme (ACE) inhibitor or angiotensin receptor blocker and statin. A small percentage (17%) was on aldosterone blockage therapy. Patients with worse DDF (stage >1) were younger, had lower systolic blood pressure, higher
Discussion
In patients with advanced ICM, DDF remains an independent predictor of all-cause mortality and heart transplantation, despite coronary revascularization and optimal contemporary medical and device therapies. DDF was found to be powerful prognostic indicator, even after adjusting for baseline clinical risk score, LVEF, MSB, and LV remodeling characteristics in this high risk population. Furthermore, our study is the first to demonstrate that diastolic function assessment provided incremental
Limitations
Although our patient cohort represents a patient population seen at a tertiary referral center, the impact of selection biases and missing/unmeasured variables may affect the findings in this study. For example, CMR was performed for clinically indicated myocardial viability assessment, thus patients with renal impairment, non-sinus rhythm/tachycardia, implanted devices (ICD/CRT/CRT-D) are not represented in the population and results may not be generally applicable. This might in part explain
Conclusions
DDF remains an independent predictor of all-cause mortality and heart transplantation in this population with advanced ICM, even after adjusting for clinical risk factors, optimal medical therapy, device therapies, coronary revascularization, and CMR-derived MSB and peri-infarct zone area. Diastolic function assessment provides incremental prognostic value to the baseline clinical characteristics and CMR data, improving risk stratification. This suggests a functional association with outcome
Disclosures
Funding: No extramural funding was used to support this work.
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