Electrocardiographic and cardiac magnetic
resonance imaging parameters as predictors
of a worse outcome in patients with
idiopathic dilated cardiomyopathy
Vinzenz Hombach1*, Nico Merkle1, Jan Torzewski1, Johann M. Kraus2,
Markus Kunze1, Oliver Zimmermann1, Hans A. Kestler2†, and Jochen Wo¨ hrle1†
Aims Clinical parameters are weak predictors of outcome in patients with idiopathic dilated cardiomyopathy (IDC). We assessed the prognostic value of cardiac magnetic resonance (CMR) parameters in addition to conventional clinical and electrocardiographic characteristics.
Methods and results One hundred and forty-one IDC patients were studied. QRS and QTc intervals were measured in 12-lead surface electrocardiogram. Patients were followed for median 1339 days, including 483 patient-years. The primaryendpoint—cardiac death or sudden death—occurred in 25 (18%) patients, including 16 patients with cardiac death, 3 patients with sudden cardiac death (SCD), and 6 patients with ICD shock. Late gadolinium enhancement (LGE) was detected in 36 patients (26%). Kaplan–Meier survival analysis displayed QRS .110 ms (P ¼ 0.010), the presence of LGE (P ¼ 0.037), and diabetes mellitus (P , 0.001) as significant parameters for a worse outcome. Multivariable analysis revealed cardiac index (P , 0.001), right ventricular end-diastolic volume index (RVEDVI) (P ¼ 0.006) derived from CMR imaging, the presence of diabetes mellitus (P ¼ 0.006), and QRS .110 ms (P ¼ 0.045) as significant predictors for the primary endpoint.
Conclusion Cardiac index and RVEDVI derived from CMR imaging in addition to QRS duration .110 ms from conventional surface ECG and diabetes mellitus provide prognostic impact for cardiac death and SCD in patients with IDC.
Keywords Idiopathic dilated cardiomyopathy † Magnetic resonance imaging † Late gadolinium enhancement † Prognosis
European Heart Journal (2009) 30, 2011–2018
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