Background
: Some patients with heart failure may have a marked improvement in left ventricular function (LVF) even in the absence of optimized drug therapy. Previous data shows that the proportion of patients matching the criteria for device implantation dropped significantly after 6 months on optimal medial therapy. However the predictors of recovery in LVF are not well understood.
Objetive
: We evaluated the feasibility of using late gadolinium enhancemnet cardiovascular magnetic resonance (LGE-CMR) to predict the improvement in LVF in new onset heart failure (AHF) patients on optimized medical therapy.
Methods
: Seventy six patients admitted with AHF and EF < 35% underwent LGE-CMR. Baseline and follow-up echocardiography was performed to assess functional recovery. We evaluated change in the proportion of patients who satisfied criteria for device implantation (EF< 35%) after 7 month on optimal therapy.
Results
: During follow-up 81% were treated with B-Blockers, 91% with ACEI and 33% with spironolactone. Twenty two patients (29%) had late gadolinium enhancement. Change in LVF was significantly hgher in patients who did not show LGE-CMR (p< 0.006). Al follo-up 55% of patients not satisfied criteria for device implantation as they developed functional recovery. Multvariate analysis showed that LGE-CMR (OR 0.10, CI 0.02–0.48, p =0.004), left bundle branch block (OR 0.14 CI 0.03–0.70, p=0.0017) and betablockers (OR 5.94 CI 1.12–31.40, p=0.006) were indepent predictors of functional recovery.
Conclusions
: The proportion of patients with AHF who satisfied criteria for device implantation as a primary prevention, dropped signifcantly after 7 months on optimal medial treatment. Late gadolinium enhancement CMR is a useful tool to identify these patients
Can late gadolinium enhancement by cardiovascular magnetic resonance identify coronary artery disease as the etiology of new onset congestive heart failure?
