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Effectiveness of late gadolinium enhancement to improve outcomes prediction in patients referred for cardiovascular magnetic resonance after echocardiography

Wong, TC and Piehler, K and Puntil, KS and Moguillansky, D and Meier, CG and Lacomis, JM and Kellman, P and Cook, SC and Schwartzman, DS and Simon, MA and Mulukutla, SR and Schelbert, EB (2013) Effectiveness of late gadolinium enhancement to improve outcomes prediction in patients referred for cardiovascular magnetic resonance after echocardiography. Journal of Cardiovascular Magnetic Resonance, 15 (1). ISSN 1097-6647

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Abstract

Background: Echocardiography (echo) is a first line test to assess cardiac structure and function. It is not known if cardiovascular magnetic resonance (CMR) with late gadolinium enhancement (LGE) ordered during routine clinical practice in selected patients can add additional prognostic information after routine echo. We assessed whether CMR improves outcomes prediction after contemporaneous echo, which may have implications for efforts to optimize processes of care, assess effectiveness, and allocate limited health care resources. Methods and results. We prospectively enrolled 1044 consecutive patients referred for CMR. There were 38 deaths and 3 cardiac transplants over a median follow-up of 1.0 years (IQR 0.4-1.5). We first reproduced previous survival curve strata (presence of LGE and ejection fraction (EF) < 50%) for transplant free survival, to support generalizability of any findings. Then, in a subset (n = 444) with contemporaneous echo (median 3 days apart, IQR 1-9), EF by echo (assessed visually) or CMR were modestly correlated (R§ssup§ 2§esup§ = 0.66, p < 0.001), and 30 deaths and 3 transplants occurred over a median follow-up of 0.83 years (IQR 0.29-1.40). CMR EF predicted mortality better than echo EF in univariable Cox models (Integrated Discrimination Improvement (IDI) 0.018, 95% CI 0.008-0.034; Net Reclassification Improvement (NRI) 0.51, 95% CI 0.11-0.85). Finally, LGE further improved prediction beyond EF as determined by hazard ratios, NRI, and IDI in all Cox models predicting mortality or transplant free survival, adjusting for age, gender, wall motion, and EF. Conclusions: Among those referred for CMR after echocardiography, CMR with LGE further improves risk stratification of individuals at risk for death or death/cardiac transplant. © 2013 Wong et al.; licensee BioMed Central Ltd.

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Details

Item Type: Article
Status: Published
Creators/Authors:
CreatorsEmailPitt UsernameORCID
Wong, TCtcw19@pitt.eduTCW19
Piehler, K
Puntil, KSksp23@pitt.eduKSP23
Moguillansky, D
Meier, CGcgm19@pitt.eduCGM19
Lacomis, JMlacomis@pitt.eduLACOMIS
Kellman, P
Cook, SC
Schwartzman, DS
Simon, MA
Mulukutla, SRsrm12@pitt.eduSRM12
Schelbert, EBers77@pitt.eduERS77
Date: 17 January 2013
Date Type: Publication
Journal or Publication Title: Journal of Cardiovascular Magnetic Resonance
Volume: 15
Number: 1
DOI or Unique Handle: 10.1186/1532-429x-15-6
Schools and Programs: School of Medicine > Medicine
School of Medicine > Radiology
Swanson School of Engineering > Bioengineering
Refereed: Yes
ISSN: 1097-6647
Date Deposited: 06 Oct 2016 19:41
Last Modified: 02 Feb 2019 16:56
URI: http://d-scholarship.pitt.edu/id/eprint/29774

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