Scarring of heart muscle linked with increased risk of death in patients with type of cardiomyopathy

Detection of midwall fibrosis (the presence of scar tissue in the middle of the heart muscle wall) via magnetic resonance imaging among patients with nonischemic dilated cardiomyopathy (a condition affecting the heart muscle) was associated with an increased likelihood of death, according to a study appearing in the March 6 issue of JAMA.

Nonischemic dilated cardiomyopathy is associated with significant illness and death due to progressive heart failure (HF) and (SCD). Despite therapeutic advances, 5-year mortality remains as high as 20 percent. "Risk stratification of patients with nonischemic dilated cardiomyopathy is primarily based on [LVEF; a measure of how well the of the with each contraction]. Superior prognostic factors may improve patient selection for implantable cardioverter-defibrillators (ICDs) and other management decisions," according to background information in the article. Attention has recently focused on whether detection of myocardial replacement fibrosis (scarring of the heart muscle) may assist with risk stratification in dilated cardiomyopathy. Fibrosis is associated with contractile impairment.

Ankur Gulati, M.D., of Royal Brompton Hospital, London, and colleagues evaluated whether midwall fibrosis (detected by late gadolinium enhancement [LGE-CMR] imaging) predicts risk of death, independently of LVEF and other established prognostic factors in dilated cardiomyopathy. The study included 472 patients with dilated cardiomyopathy referred to a U.K. center for CMR imaging between November 2000 and December 2008 after presence and extent of midwall replacement fibrosis (scarring of the heart muscle present in the middle of the heart muscle wall) were determined. Patients were followed up through December 2011.

During a median (midpoint) follow-up of 5.3 years, there were 73 deaths. Overall, 38 of 142 patients with midwall fibrosis (26.8 percent) died compared with 35 of 330 patients without midwall fibrosis (10.6 percent). After analysis, both the presence and percentage extent of midwall fibrosis were significant independent predictors of all-cause mortality. The arrhythmic composite end point (SCD or aborted SCD) occurred in 65 patients (14 percent). Analysis indicated that patients with midwall fibrosis were more than 5 times more likely to experience SCD or aborted SCD compared with patients without midwall fibrosis (29.6 percent vs. 7.0 percent).

"After adjustment for LVEF and other conventional prognostic factors, both the presence of fibrosis and the extent were independently and incrementally associated with all-cause mortality. Fibrosis was also independently associated with cardiovascular mortality or cardiac transplantation, SCD or aborted SCD, and the HF composite [HF death, HF hospitalization, or cardiac transplantation]," the authors write.

Also, the addition of fibrosis to LVEF significantly improved risk reclassification for all-cause mortality and the SCD composite.

"Our findings suggest that detection and quantification of midwall fibrosis by LGE-CMR may represent useful markers for the of death, ventricular arrhythmia, and HF for patients with dilated cardiomyopathy," the researchers write.

More information: JAMA. 2013;309(9):896-908

add to favorites email to friend print save as pdf

Related Stories

SCAI: Ixmyelocel-T studied for dilated cardiomyopathy

May 15, 2012

(HealthDay) -- For patients with dilated cardiomyopathy, treatment with an autologous bone marrow-derived, expanded multi-cell product, ixmyelocel-T, is well tolerated and associated with improved symptoms ...

Increased sudden cardiac death rate among HIV patients

May 16, 2012

(HealthDay) -- Patients with HIV/AIDS have a significantly increased risk of sudden cardiac death (SCD), according to a study published in the May 22 issue of the Journal of the American College of Cardiology.

Good transplant outcomes in hypertrophic cardiomyopathy

Aug 17, 2012

(HealthDay) -- Post-heart transplant survival does not differ significantly between patients with hypertrophic cardiomyopathy (HC) and those with other types of heart disease, according to a study published in the Aug. 15 ...

Recommended for you

Beating the clock for ischemic stroke sufferers

1 hour ago

A ground-breaking computer technology raises hope for people struck by ischemic stroke, which is a very common kind of stroke accounting for over 80 per cent of overall stroke cases. Developed by research experts at The Hong ...

Risk for nonelective thoracic aortic sx up for uninsured

16 hours ago

(HealthDay)—Uninsured patients have an increased risk of nonelective thoracic aortic operations, and have increased risks of major morbidity or mortality, according to a study published online April 8 in ...

A global view on the prevention of cardiovascular disease

Apr 15, 2014

The United Nations and the World Health Organization pledged in 2011 to reduce premature mortality from non-communicable diseases - most notably cardiovascular diseases - by 25% by the year 2025. It's an ambitious target, ...

User comments