Abstract 10063: Can Cardiac MRI be the ‘Crystal Ball’ for Risk Stratification in Dilated Cardiomyopathy; the Impact of an LV Mid-Myocardial Stripe on Subsequent Risk of LVAD, Transplantation and Death

Introduction Patients with newly diagnosed dilated cardiomyopathy (DCM) and advanced heart failure have a very high morbidity and mortality with an unpredictable clinical course. We investigated the role of CMR via LGE (late gadolinium enhancement) in this cohort of high-risk patients. Hypothesis Utilizing cardiovascular MRI (CMR), we assessed the prognostic value of LGE in primary dilated DCM patients referred for possible transplantation/LVAD consideration. Methods Over 49 consecutive months, 61 consecutive DCM pts were referred for standard 3D CMR (1.5T,GE) to interrogate the LV pattern, distribution and extent of LGE (MultiHance, Princeton, NJ). Inclusion criteria for a primary non-ischemic dilated DCM and EF Results There were no differences between groups for demographics, baseline LVEF, NYHA class or invasive hemodynamics. There were 18/31 (58%) pts with + mid-wall Stripe. Nine events occured: 7 pts required urgent Tx ± LVAD and 2 pts died among the 31 pts. The group with +Stripe categorization strongly predicted the need for LVAD, urgent Tx surgery and death over the ensuing 12 months (Kaplan-Meier: X 2 = 9, p never experienced the need for Tx, LVAD or death, indeed revealing signs of improvement in NYHA and LVEF (p Conclusions The presence of +Stripe on CMR is strongly predictive of LVAD, transplant need and death over the ensuing 12 months in DCM patients. All −Stripe pts possess a 100% favorable sign through one year. Incorporating CMR imaging into routine clinical practice may help to identify DCM risk; conservatively manage low-risk patients while expectantly manage high-risk patients.