Right ventricular insertion site fibrosis in a dilated cardiomyopathy referral population: phenotypic associations and value for the prediction of heart failure admission or death

• Published in: Journal of cardiovascular magnetic resonance 2021-06, Vol.23 (1), p.79-79, Article 79
• Main Authors: Mikami, Yoko, Cornhill, Aidan, Dykstra, Steven, Satriano, Alessandro, Hansen, Reis, Flewitt, Jacqueline, Seib, Michelle, Rivest, Sandra, Sandonato, Rosa, Lydell, Carmen P, Howarth, Andrew G, Heydari, Bobak, Merchant, Naeem, Fine, Nowell, White, James A
• Format: Article
• Language: English
• Subjects: Adult; Aged; Automation; Cardiomyopathy; Cardiomyopathy, Dilated - diagnostic imaging; Cardiovascular magnetic resonance; Clinical outcomes; Congestive heart failure; Contrast Media; Coronary vessels; Criteria; Death; Dilated cardiomyopathy; Ejection fraction; Female; Fibrosis; Gadolinium; Heart; Heart attacks; Heart diseases; Heart failure; Heart Failure - diagnostic imaging; Heart Failure - etiology; Humans; Hypertension; Insertion; Laboratories; Magnetic resonance; Magnetic resonance imaging; Magnetic Resonance Imaging, Cine; Male; Markers; Medical imaging; Middle Aged; Mortality; Patients; Phenotype; Phenotypes; Population; Predictive Value of Tests; Prognosis; Pulmonary arteries; Referral and Consultation; Remodeling; Risk; Software; Veins & arteries; Ventricle
• ISSN: 1097-6647; 1532-429X
• DOI: 10.1186/s12968-021-00761-0

Dilated cardiomyopathy (DCM) is increasingly recognized as a heterogenous disease with distinct phenotypes on late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR) imaging. While mid-wall striae (MWS) fibrosis is a widely recognized phenotypic risk marker, other fibrosis patterns are prevalent but poorly defined. Right ventricular (RV) insertion (RVI) site fibrosis is commonly seen, but without objective criteria has been considered a non-specific finding. In this study we developed objective criteria for RVI fibrosis and studied its clinical relevance in a large cohort of patients with DCM. We prospectively enrolled 645 DCM patients referred for LGE-CMR. All underwent standardized imaging protocols and baseline health evaluations. LGE images were blindly scored using objective criteria, inclusive of RVI site and MWS fibrosis. Associations between LGE patterns and CMR-based markers of adverse chamber remodeling were evaluated. Independent associations of LGE fibrosis patterns with the primary composite clinical outcome of heart failure admission or death were determined by multivariable analysis. The mean age was 56 ± 14 (28% female) with a mean left ventricular (LV) ejection fraction (LVEF) of 37%. At a median of 1061 days, 129 patients (20%) experienced the primary outcome. Any abnormal LGE was present in 306 patients (47%), inclusive of 274 (42%) meeting criteria for RVI site fibrosis and 167 (26%) for MWS fibrosis. All with MWS fibrosis showed RVI site fibrosis. Solitary RVI site fibrosis was associated with higher bi-ventricular volumes [LV end-systolic volume index (78 ± 39 vs. 66 ± 33 ml/m , p = 0.01), RV end-diastolic volume index (94 ± 28 vs. 84 ± 22 ml/m (p