Incremental prognostic role of fat replacement over late gadolinium enhancement in patients with non-dilated left ventricular cardiomyopathy and preserved systolic function

Abstract Abstract In the definition of non-dilated left ventricular cardiomyopathy (NDLVC), recent European Society of Cardiology guidelines, included the findings of non ischemic myocardial fibrosis and/or fatty replacement (FR), with or without regional or global LV dysfunction. However, the prognostic role of FR is still unclear in patients with preserved LV ejection fraction (EF). Objective to evaluate the prognostic role of FR compared to late gadolinium enhancement (LGE) in subjects with NLDVC, preserved LVEF and frequent premature ventricular complexes (PVC). Methods cardiac magnetic resonance was performed in 900 consecutive patients with frequent PVC, preserved LVEF. Patients with diagnostic criteria for other cardiomyopathies, channelopathies and ischemic disease were excluded. A clinical follow-up was performed and major ventricular arrhythmias (MVA), including sudden cardiac death, appropriated ICD intervention, and sustained VT, were considered endpoints. Results The final population included 876 patients. Overall non-ischemic LGE was found in 101 (12%) patients and FR in 38 (4%): 87 (10%) presenting LGE without FR, 14 (1,6%) FR without LGE and 24 (3%) LGE with FR. After a median follow-up of 4 (3-6) years, MVA occurred in 43 patients. At Kaplan-Meier survival curve analysis (figure 1) the presence of LGE and/or FR was associated with worse prognosis than their absence. The group of patients with worse prognosis was that with the combined LGE+FR. A similar prognosis was found in patients with LGE alone and in those with FR alone (p=0.19). Patients with LGE+FR had worse prognosis than those with LGE alone (P=0.01). At univariate analysis non- sustained VT (NSVT), syncope, LGE, FR and LGE+FR were associated to MVA. At multivariable logistic regression analysis the combination LGE+FR was an independent predictor of MVA together with history of NSVT and syncope. Conclusions in NDLVC with preserved LVEF, the combination of FR+LGE was a stronger prognostic marker than the presence of LGE alone. FR and LGE had similar prognostic role when found separately.