Prognostic Value Of Delayed Gadolinium-enhanced Cardiac Magnetic Resonance Imaging In Patients With Non-ischemic Cardiomyopathy

Objective:To study the delayed gadolinium-enhanced cardiac magnetic resonance imaging(LGE-CMR)of 137 patients with non-ischemic cardiomyopathy((NICM)),combined with serum markers,ECG markers and left ventricular ejection fraction(LVEF),and to find out the prognostic value of LGE-CMR to NICM through follow-up,so as to better stratify the risk of prognosis for NICM patients,and then choose the best treatment in time.Methods:The subjects were 137 NICM inpatients who were evaluated by delayed gadolinium-enhanced cardiac magnetic resonance imaging(LGE-CMR)in the first Hospital of Jilin University from February 2016 to February 2020,and coronary atherosclerotic heart disease was excluded.In addition,the following risk indicators were also evaluated: NYHA functional rating ≥ II,BNP > 100 ng,cTnI >0.03 mg,LVEF ≤ 35%,LVEDD > 55 mm and QRS > 105 ms.The endpoints of the study were death from various causes,heart transplantation,attempted sudden death,persistent ventricular tachycardia or hospitalization for decompensated heart failure.Results:After the diagnosis was completed with CMR and other examinations,84patients(61.3%)were diagnosed with dilated cardiomyopathy(DCM),10 patients(11.7%)were diagnosed as acute,subacute or chronic myocarditis,16 patients(11.7%)were diagnosed with hypertrophic cardiomyopathy(HCM).11 patients(8.0%)were diagnosed with arrhythmogenic right ventricular cardiomyopathy(ARVC);and16 patients(7.3%)with myocardial amyloidosis.Of the 137 patients,93(67.9%)were positive for LGE.Among them,the most common enhancement mode of LGE is Diffuse Enhancemengt(n=26,19%);other modes: Transmural enhancement(n=7,5.1%);Subendocardial enhancement of(n=17,12.4%);Subepicardial enhancement(nasty 11,8.0%);Mesocardial Enhancement(n=13,9.5%).Nodular or patchy(n=13,9.5%);RV Enhancement(n=6 4.4%).When grouping and comparing the baseline data,the LVEF of LGE positive patients was significantly lower than that of non-LGE patients(29.50 ±15.46% and 34.86 ±12.97%,p= 0.011).The duration of QRS in LGE positive patients was significantly higher than that in LGE negative patients(108.77±27.09 ms and 99.32 ±19.76 ms,p= 0.011).In addition,the level of CTnI in IgE positive patients was higher(1.45 ±6.89 ng/l and 0.14 ±0.67 ng/l,p=0.017).There was no difference between IgE positive and negative patients in terms of age,sex,LVED,past medical history and cardiac drug therapy.During the median follow-up period of16 months,64 patients(46.7%)reached the comprehensive end point and 10 cases(7.3%)died;3 cases(2.2%)were resuscitated successfully due to cardiac arrest;5cases(3.6%)were treated with ICD in our hospital or outside hospital;30 cases(21.9%)recorded persistent ventricular tachycardia.50 cases(36.5%)were re-admitted to our hospital or admitted to the local hospital for decompensated heart failure;26 cases(19.0%)reached the end point of review(reached 2 or more clinical endpoints).In the multivariate analysis of NICM prognosis,LGE+(HR=3.0;95%CI:1.5-5.8;),BNP > 100 ng/l(HR=4.3;95%CI:1.5-11.9;p=0.005)and QRS > 105ms(HR=2.0;95%CI:1.2-3.3;p= 0.006)were independent predictors of adverse event in NICM,and BNP > 100 ng/l was the strongest predictor of adverse event in NICM.In the multivariate analysis of most of the patients in the sample DCM(61.3%),LGE+(HR=5.5;95%CI:2.313);QRS > 105ms(HR=2.3;95%CI:1.2-4.4;p=0.012)was an independent predictor of adverse event,and LGE+ was the strongest predictor of adverse event.Conclusion:1.In patients with non-ischemic cardiomyopathy,the prognosis of LGE positive patients was significantly worse than that of LGE negative patients.2.In multivariate analysis,LGE+,BNP > 100ng/l and QRS > 105 ms were independent predictors of adverse event in NICM,and BNP > 100ng/l was the strongest independent predictor.3.When patients diagnosed with DCM as samples for multivariate analysis,LGE+ and QRS > 105 ms were independent predictors of adverse event,and LGE+was the strongest independent predictor.4.Compared with LGE negative patients,LVEF decreased,QRS interval and cTnI level increased in LGE positive patients.