The tissue characterization offered by Cardiac Magnetic Resonance (CMR) with late gadolinium enhancement (LGE) in dilated cardiomyopathy (DCM) according to the different LGE patterns, together with clinical and morphological data, allow us to know the etiological diagnosis, its specific treatment and establish a forecast.
We value the utility in the etiological diagnosis of CMR with RT in patients with idiopathic DCM diagnosed with echocardiography and coronary angiography.
PURPOSE AND METHODS
We performed CMR with RT in 75 consecutive patients referred from Cardiology during the years 2017 and 2018 with the diagnosis of dilated cardiomyopathy in whom significant obstructive coronary disease had been ruled out.
In the cohort of 75 patients, 45 (69%) were men with an average age of 62 years. Arterial hypertension 80%, Dislipemia 20%, Diabetes 10% and smokers 25%.
All patients had optimal pharmacological treatment at maximum tolerated doses (except Sacubitril / Valsartan, only in 33 (45%) patients).
Global hypokinesia 85%. The mean end-diastolic and end-systolic volumes of the LV were 119 ml and 79 ml respectively. Average ejection fraction of the left ventricle (EFLV) was 31%. The average left ventricular mass was 84 g / m2.
The following LGE patterns were obtained: Subendocardial 31% (23). Mesoventricular patch 20% (n = 15). Subepicardial 20% (n = 15). Absence of RT 29% (n = 22).
Patients with LGE had higher volumes (p = 0.04) and worse left ventricular function (p <0.001).
The LGE sequences allow us to reorient the diagnosis of patients who had previously been diagnosed with idiopathic DCM.
A not insignificant percentage of cases were found to be dilated cardiomyopathy of ischemic etiology or secondary to previous myocarditis, with the prognostic, therapeutic and economic implications that this entails.
In our study, the presence of RT is associated with worse left ventricular function.