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Home » Topics » Imaging
Publish Date May 12, 2022
IDIOPATHIC DILATED CARDIOMYOPATHY DIAGNOSIS AND LATE GADOLINIUM ENHANCEMENT CMR
Ron Goldberg
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Cardiomyopathy impacts disease prognosis and course, as well as therapeutic
strategy, therefore early appropriate classification is vital. Credit:
Shutterstock
Among patients with dilated cardiomyopathy (DCM) and late gadolinium enhancement
cardiovascular magnetic resonance (LGE-CMR) data available in the Dilated
Cardiomyopathy Precision Medicine Study cohort, the clinical diagnostic criteria
used in that study correctly classified ischemic and nonischemic causes of DCM,
according to research findings published in Circulation: Heart Failure.
Identifying myocardial scar and its cause with LGE-CMR has been recently
considered for patients with idiopathic DCM. In the DCM Precision Medicine Study
(ClinicalTrials.gov identifier: NCT03037632), researchers sought to assess the
cause of DCM and investigate LGE patterns for possible prior ischemic events in
an effort to validate the diagnostic criteria the study used.
To accomplish this, they conducted a retrospective evaluation of the DCM
Precision Medicine multi-site consortium study. This included 1204 idiopathic
DCM patients, of whom 396 had prior CMR examination, 327 (mean aged 46 years;
53.2% men; 55.4% White) had LGE imaging. Idiopathic DCM was defined as the
exclusion of all other clinically detectable causes of DCM, except genetic.
These patients exhibited tobacco use (40.4%), obesity (48.3%), high cholesterol
(23.9%), hypertension (46.2%), and diabetes (17.4%). Among these patients, 178
showed LGE, of whom 156 had LGE consistent with idiopathic DCM.
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Continue Reading
In prior studies, LGE has identified replacement fibrosis from causes including
prior heart attack. Proposed LGE patterns were created to assign cause as
ischemic or nonischemic. An ischemic-pattern of LGE was recognized in 22 (6.7%)
of the 327 patients in this study.
Study limitations included the underpowered sample size, the fact that actual
CMR images were not reviewed, and the heterogeneity of image acquisition
protocols and interpretation.
The researchers concluded, “This study validated the clinical diagnostic
criteria used in the DCM Precision Medicine Study, demonstrating its accuracy in
classification of ischemic and nonischemic causes of DCM.”
REFERENCE
Haas GJ, Zareba KM, Ni H, Bello-Pardo E, Huggins GS, Hershberger RE. Validating
an idiopathic dilated cardiomyopathy diagnosis using cardiovascular magnetic
resonance: The Dilated Cardiomyopathy Precision Medicine Study. Circ Heart Fail.
Published online March 4, 2022. doi:10.1161/CIRCHEARTFAILURE.121.008877
TOPICS:
Cardiomyopathy Preventive Medicine
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