Abstract
Background - In some patients with heart failure, β-blockers can improve left ventricular (LV) function and reduce morbidity and mortality. We hypothesized that gadolinium-enhanced cardiovascular magnetic resonance imaging (CMR) can predict reversible myocardial dysfunction and remodeling in heart failure patients treated with β-blockers. Methods and Results - Forty-five patients with chronic heart failure underwent CMR. Contrast imaging using gadolinium was performed to obtain high-resolution spatial maps of myocardial scarring and viability. Cine imaging was performed to assess LV function and morphology and was repeated in 35 patients after 6 months of β-blockade. Gadolinium CMR demonstrated scarring in 30 of 45 patients (67%). Scarring was found in 100% of patients with ischemic cardiomyopathy (28 of 28) but in only 12% with nonischemic cardiomyopathy (2 of 17). In the 35 patients who were maintained on β-blockers and had a second study, there was an inverse relation between the extent of scarring at baseline and the likelihood of contractile improvement 6 months later (P<0.001). For instance, contractility improved in 56% (674 of 1207) of regions with no scarring but in only 3% with >75% scarring (8 of 232). Multivariate analysis showed that the amount of dysfunctional but viable myocardium by CMR was an independent predictor of the change in ejection fraction (P=0.01), mean wall motion score (P=0.0007), LV end-diastolic volume index (P=0.007), and LV end-systolic volume index (P<0.0001). Conclusions - For heart failure patients treated with β-blockers, gadolinium-enhanced CMR predicts the response in LV function and remodeling.
Original language | English (US) |
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Pages (from-to) | 1945-1953 |
Number of pages | 9 |
Journal | Circulation |
Volume | 108 |
Issue number | 16 |
DOIs | |
State | Published - Oct 21 2003 |
Keywords
- Cardiomyopathy
- Heart failure
- Magnetic resonance imaging
- Receptors, adrenergic, beta
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine
- Physiology (medical)