22 July 2018 : Clinical Research
Overlapping Phenotypes and Degree of Ventricular Dilatation Are Associated with Severity of Systolic Impairment and Late Gadolinium Enhancement in Non-Ischemic CardiomyopathiesMarko Boban123ABDEF, Vladimir Pesa1BD, Viktor Persic123DF, Marinko Zulj23CE, Ivan Malcic45DE, Natko Beck1BD, Aleksandar Vcev23EF
Med Sci Monit 2018; 24: CLR5084-5092
BACKGROUND: Dilatation and other infrastructural rearrangements of the left ventricle are connected with poor prognosis. The aim of our study was to analyze the overlapping phenotypes and dilatation of the ventricle on impairment of systolic function and existence of late gadolinium enhancement (LGE).
MATERIAL AND METHODS: Consecutive sample of cases with dilated left ventricle due to non-ischemic cardiomyopathy and healthy controls were included from our cardiac magnetic resonance imaging (CMR) database for a period of 3 years (n=1551 exams).
RESULTS: The study included 127 patients; 30 (23.6%) with dilated cardiomyopathy (DCM); 30 (23.6%) with left ventricular non-compaction (LVNC); 13 (10.2%) with hypertrophic cardiomyopathy (HCM), and 50 (39.4%) controls. Overlapping phenotypes were found in 48 (37.8%) of the studied cases. Odds for impairment of systolic function in connection with overlapping phenotypes were estimated at 7.8 (95%-CI: 3.4–17.6), (p<0.001). There were significant differences in geometric parameters for patients with overlapping phenotypes vs. controls, as follows: left ventricle end-diastolic dimension(LVEDD)=6.6±0.8 vs. 5.6±1.0 cm (p<0.001); left ventricular ejection fraction (LVEF)=39.3±14.0 vs. 52.1±16.1 (p<0.001); and existence of LGE 36 (75.0%) vs. 21 (26.6%), (p<0.001), respectively. Overlapping phenotypes correlated with LVEDD (Spearman’s-Rho-CC)=0.521, p<0.001; LVEF (Rho-CC)=–0.447, p<0.001 and LGE (Rho-CC)=0.472, p<0.001.
CONCLUSIONS: This study found there are many patients with overlapping phenotypes among NICMPs with dilated left ventricles. Overlapping phenotype was associated with greater LVEDD, lesser systolic function, and commonly existing LGE, which all impose increased cardiovascular risk. Linear midventricular LGE stripe was the most powerfully connected with loss of systolic function.
Keywords: Cardiomyopathy, Dilated, Gadolinium DTPA, Heart Failure, Magnetic Resonance Imaging, Ventricular Remodeling, Cardiomyopathy, Hypertrophic, Genes, Overlapping
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