Predictors of prognosis by cardiac magnetic resonance imaging in patients with idiopathic restrictive heart disease

TL;DR

This study shows that cardiac MRI can predict outcomes in patients with idiopathic restrictive heart disease by analyzing strain and tissue damage.

Contribution

The study identifies GLS and LGE as independent CMR predictors of mortality and heart failure in idiopathic RCM.

Findings

GLS greater than -9.5% independently predicted mortality and heart failure hospitalization.

LGE was a strong predictor of both mortality and heart failure hospitalization.

Patients had preserved ejection fractions despite impaired strain values.

Abstract

Restrictive cardiomyopathy (RCM) is characterized by increased myocardial stiffness, impaired diastolic filling, and preserved systolic function until advanced stages. Cardiac magnetic resonance imaging (CMR) provides precise strain analysis and tissue characterization, yet its prognostic value in idiopathic RCM remains underexplored. This study aims to evaluate the prognostic significance of CMR parameters, particularly myocardial strain and late gadolinium enhancement (LGE), in predicting outcomes in patients with idiopathic RCM.

Patients demonstrated moderately impaired strain values, with global longitudinal strain (GLS) measured at −10.59 ± 4.64% and global circumferential strain (GCS) at −14.50 ± 4.98%, while maintaining preserved biventricular ejection fractions. LGE was present in 40% of patients. A GLS value greater than −9.5% independently predicted mortality (odds ratio [OR]: 1.195, p = 0.044) and heart failure (HF) hospitalization (OR: 1.152, p = 0.013). Additionally, LGE emerged as a strong independent predictor of both mortality (OR: 6.340, p = 0.004) and HF hospitalization (OR: 4.654, p = 0.001).

CMR is a valuable tool for prognostication in idiopathic RCM. GLS and LGE are independent predictors of adverse outcomes.

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