Non-ischemic Primary and Secondary Cardiomyopathy
Andrea Guala, PhD
Senior Researcher
Hospital Universitari Vall d'Hebron, CIBER-CV
barcelona, Catalonia, Spain
Maribel Gonzalez del Hoyo
MD
Hospital Universitari Vall d'Hebron, Spain
Guillem Casas, MD
MD
Hospital Universitari Vall d'Hebron, Spain
Andrea Romero
MD
Hospital Universitari Vall d'Hebron, Spain
Maria Josefa Azpiroz-Franch
MD
Hospital Universitari Vall d'Hebron, Spain
Jose M Larrañaga Moreira
MD
Hospital Universitario da Coruña, Spain
Roxana Escalona Silvina
MD
Hospital Universitari Vall d'Hebron, Spain
Antoni Bayes Genis, Department of Medicine, Universitat Autònoma de Barcelona, Barcelona
MD
Hospital Universitari Germans Trias i Pujol, Spain
Esther Zorio Grima
MD
Hospital La Fe Valencia, Spain
Eduardo Villacorta Arguelles
MD
Salamanca University Hospital, Spain
Javier Limeres
MD
Hospital Universitari Vall d'Hebron, Spain
Pablo Garcia Pavia
MD
Hospital Puerta de Hierro, Spain
Roberto Barriales Villa
MD
Hospital Universitario da Coruña, Spain
Ignacio Ferreira Gonzalez, MD, PhD
MD
Hospital Universitari Vall d'Hebron, Spain
Jose F Rodriguez Palomares, MD, PhD, FSCMR
Cardiologist
Hospital Universitari Vall d'Hebron
Barcelona, Spain
This was a retrospective longitudinal multicenter cohort study of consecutive patients fulfilling LVNC criteria by echocardiography or cardiovascular magnetic resonance (CMR) between 2001-2008. CMR was performed at 1.5T and LVHDF were analyzed with a prototype software(Medis Suite Qstrain).LVHDF were calculated as lateral-septal/radial-LVHDF and inferior-anterior/long-LVHDF. MACE was defined as a composite of heart failure(HF), ventricular arrhythmias(VA), systemic embolisms(SE) or all-cause mortality. We performed descriptive statistical analysis, ROC analyses, Spearman correlation, as well as survival analyses.
Results:
The final study population included 321 patients,43% were female and age at diagnosis was 44.5±19.2years. After median follow-up of 2.8 (IQR1.0-5.4) years, 72(22.4%) patients experienced at least 1 MACE. Patients with MACE were significantly older, had more CV risk factors , a higher LVNC risk score, and worse CMR parameters(Table 1). There was a significant moderate correlation between LV GLS and LVEF (r=0.652;p < 0.001) and between Long-LVHDF and LVEF(r=0.551;p < 0.001).However, there was a weak correlation for radial-LVHDF and LVEF(r =0.393;p < 0.001). We compared the CMR indices and the LVNC risk score using ROC curves with the DeLong method. There were significant differences among the 4 parameters(P < 0.040), with LVNC risk score having the highest AUC (AUC 0.825, CI95% 0.771-0.879) followed by AIEF (AUC 0.785, CI95% 0.718-0.852), Long-LVHDF (AUC 0.768, CI95% 0.700-0.835) and LVEF (AUC 0.751, CI95% 0.673-0.828). However, the best predictive performance for MACE was found with LVNC risk score, Long-LVHDF and LAFE (AUC 0.87 (0.82-0.91); p=0.02)(Figure 1). Long-LVHDF < 8.5% was associated with a higher unadjusted MACE rate(28.5% vs 68.8%, p log rank < 0.001), as well as LAEF < 42% (22.8% vs 66.2%, p log rank < 0.001) (Figure2). On multivariate Cox regression analysis, adjusted for LVNC score, Long-LVHDF was independently associated with MACE (HR 0.89 CI95% 0.82-0.96, p=0.004) while LVEF was not (HR 0.99, 95%CI 0.97-1.01, p=0.424).
Conclusion:
In LVNC, the analysis of hemodynamic forces had an adequate correlation with LVEF. Both LVEF and longitudinal LVHDF were significantly reduced in patients with MACE, however, only misalignment of long-LVHDF was independently associated with outcomes. Furthermore, LVHDF and LAEF, in addition to LVNC risk score, improved prediction of MACE, and may serve as additional tools for prognosis.