Journal
EUROPEAN HEART JOURNAL-CARDIOVASCULAR IMAGING
Volume 22, Issue 10, Pages 1197-1207Publisher
OXFORD UNIV PRESS
DOI: 10.1093/ehjci/jeaa144
Keywords
idiopathic dilated cardiomyopathy; remodelling index; cardiovascular magnetic resonance; prognosis
Funding
- National Natural Science Foundation of China [81571638]
- 1.3.5 project for disciplines of excellence Clinical Research Incubation Project, West China Hospital, Sichuan University [ZYJC18013, Z2018A08]
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The left ventricular remodeling index (RI) is an independent predictor of all-cause mortality, heart transplantation, and HF readmission in patients with idiopathic dilated cardiomyopathy (DCM), providing additional prognostic value beyond traditional measures like left ventricular ejection fraction (LVEF) and late gadolinium enhancement (LGE) presence.
Aims To evaluate the prognostic value of left ventricular (LV) remodelling index (RI) in idiopathic dilated cardiomyopathy (DCM) patients. Methods and results We prospectively enrolled 412 idiopathic DCM patients and 130 age- and sex-matched healthy volunteers who underwent cardiovascular magnetic resonance imaging between September 2013 and March 2018. RI was defined as the cubic root of the LV end-diastolic volume divided by the mean LV wall thickness on basal short-axis slice. The primary endpoint included all-cause mortality and heart transplantation. The secondary endpoint included the primary endpoint and heart failure (HF) readmission. During the median follow-up of 28.1months (interquartile range: 19.3-43.0months), 62 (15.0%) and 143 (34.7%) patients reached the primary and secondary endpoints, respectively. Stepwise multivariate Cox regression showed that RI [hazard ratio (HR) 1.20, 95% confidence interval (CI) 1.11-1.30, P<0.001], late gadolinium enhancement (LGE) presence and log (N-terminal pro-B-type natriuretic peptide) were independent predictors of the primary endpoint, while RI (HR 1.15, 95% CI 1.08-1.23, P<0.001) and extracellular volume were independent predictors of the secondary endpoint. The addition of RI to LV ejection fraction (EF) and LGE presence showed significantly improved global chi(2) for predicting primary and secondary endpoints (both P<0.001). Furthermore, RI derived from echocardiography also showed independent prognostic value for primary and secondary endpoints with clinical risk factors. Conclusions RI is an independent predictor of all-cause mortality, heart transplantation, and HF readmission in DCM patients and provides incremental prognostic value to LVEF and LGE presence.
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