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Prognostic implications of late gadolinium enhancement at the right ventricular insertion point in patients with non-ischemic dilated cardiomyopathy: A multicenter retrospective cohort study

Title
Prognostic implications of late gadolinium enhancement at the right ventricular insertion point in patients with non-ischemic dilated cardiomyopathy: A multicenter retrospective cohort study
Authors
Yi, Jeong-EunPark, JunbeomLee, Hye-JeongShin, Dong GeumKim, YookyungKim, MinsukKwon, KihwanPyun, Wook BumKim, Young JinJoung, Boyoung
Ewha Authors
김유경권기환편욱범김민석박준범이정은
SCOPUS Author ID
김유경scopus; 권기환scopus; 편욱범scopus; 김민석scopus; 박준범scopus; 이정은scopus
Issue Date
2018
Journal Title
PLOS ONE
ISSN
1932-6203JCR Link
Citation
PLOS ONE vol. 13, no. 11
Publisher
PUBLIC LIBRARY SCIENCE
Indexed
SCIE; SCOPUS WOS
Document Type
Article
Abstract
Introduction The presence of late gadolinium enhancement (LGE) at the right ventricular insertion point (RVIP) on cardiac magnetic resonance (CMR) is generally believed to be nonspecific, but the clinical implication of this unique LGE pattern in patients with non-ischemic dilated cardiomyopathy (NICM) has not been elucidated. Objectives We investigated the prognostic significance of RVIP-LGE in NICM patients. Methods A total of 360 consecutive NICM patients referred for CMR (102 with no LGE, 50 with RVIP-LGE, 121 with left ventricular [LV]-LGE, and 87 with both an LV and RVIP-LGE) were studied. The primary endpoint was a composite of the all-cause death, hospitalization due to worsening of heart failure, and major arrhythmic events. Results During a mean follow-up of 45.2 +/- 36.5 months, 149 (41.4%) patients (22 [21.6%] no LGE vs. 16 [32.0%] RVIP-LGE vs. 62 [51.2%] LV-LGE vs. 49 [56.3%] both LV and RVIP-LGE, P < 0.0001) reached the primary endpoint. A Kaplan Meier curve demonstrated that RVIP-LGE patients had an intermediate trend of an event free survival rate for the composite end-point log-rank P < 0.0001). In a multivariable Cox regression model, LV-LGE P = 0.008) and both LV and RVIP-LGE P = 0.003) were significantly associated with a worse outcome, whereas RVIP-LGE was not P = 0.101). In addition, RVIP-LGE patients n = 32) had a more favorable outcome compared to LV-LGE patients n = 32) even after matching the extent of the LGE median 3.4% [interquartile range, 3.1-3.8], 8 [25.0%] RVIP-LGE vs. 20 [62.5%] LV-LGE, P = 0.002). Conclusions LGE confined to the RVIP among NICM patients did not significantly increase the risk of adverse cardiac events, and also showed a better outcome than the same extent of LGE located in the LV. Identification of this unique LGE distribution may help refine the current risk stratification.
DOI
10.1371/journal.pone.0208100
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의과대학 > 의학과 > Journal papers
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