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European Heart Journal Advance Access originally published online on July 24, 2009
European Heart Journal 2009 30(16):2011-2018; doi:10.1093/eurheartj/ehp293
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2009. For permissions please email: journals.permissions@oxfordjournals.org
The online version of this article has been published under an open access model. Users are entitled to use, reproduce, disseminate, or display the open access version of this article for non-commercial purposes provided that the original authorship is properly and fully attributed; the Journal, Learned Society and Oxford University Press are attributed as the original place of publication with correct citation details given; if an article is subsequently reproduced or disseminated not in its entirety but only in part or as a derivative work this must be clearly indicated. For commercial re-use, please contact journals.permissions@oxfordjournals.org

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,{dagger} and Jochen Wöhrle1,{dagger}

1 Clinic of Internal Medicine II, University Hospital Ulm, Albert-Einstein-Allee 23, 89081 Ulm, Germany
2 Neural Information Processing System, University of Ulm, Ulm, Germany

Received 8 August 2008; revised 4 May 2009; accepted 2 July 2009; online publish-ahead-of-print 24 July 2009.

* Corresponding author. Tel: +49 731 500 45000, Fax: +49 731 500 45005, Email: vinzenz.hombach{at}uniklinik-ulm.de

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 primary endpoint—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 = 0.010), the presence of LGE (P = 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 = 0.006) derived from CMR imaging, the presence of diabetes mellitus (P = 0.006), and QRS >110 ms (P = 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.

Key Words: Idiopathic dilated cardiomyopathy • Magnetic resonance imaging • Late gadolinium enhancement • Prognosis

{dagger} J.W. and H.A.K. should both be considered senior authors.


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