AIMS There is an important need for better biomarkers to predict left ventricular (LV) remodelling in dilated cardiomyopathy (DCM). We undertook a comprehensive assessment of cardiac structure and myocardial composition to determine predictors of remodelling. METHODS AND RESULTS Prospective study of patients with recent-onset DCM with cardiovascular magnetic resonance (CMR) assessment of ventricular structure and function, extracellular volume (T1 mapping), myocardial strain, myocardial scar (late gadolinium enhancement) and contractile reserve (dobutamine stress). Regression analyses were used to evaluate predictors of change in LV ejection fraction (LVEF) over 12 months. We evaluated 56 participants (34 DCM patients, median LVEF 43%; 22 controls). Absolute LV contractile reserve predicted change in LVEF (1% increase associated with 0.4% increase in LVEF at 12 months, P = 0.02). Baseline myocardial strain (P = 0.39 global longitudinal strain), interstitial myocardial fibrosis (P = 0.41), replacement myocardial fibrosis (P = 0.25), and right ventricular contractile reserve (P = 0.17) were not associated with LV reverse remodelling. There was a poor correlation between contractile reserve and either LV extracellular volume fraction (r = -0.22, P = 0.23) or baseline LVEF (r = 0.07, P = 0.62). Men were more likely to experience adverse LV remodelling (P = 0.01) but age (P = 0.88) and disease-modifying heart failure medication (beta-blocker, P = 0.28; angiotensin-converting enzyme inhibitor, P = 0.92) did not predict follow-up LVEF. CONCLUSIONS Substantial recovery of LV function occurs within 12 months in most patients with recent-onset DCM. Women had the greatest improvement in LVEF. A low LV contractile reserve measured by dobutamine stress CMR appears to identify patients whose LVEF is less likely to recover.

中文翻译：

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扩张型心肌病患者左心室重构的预测因子——心血管磁共振研究。

目的 非常需要更好的生物标志物来预测扩张型心肌病 (DCM) 中的左心室 (LV) 重塑。我们对心脏结构和心肌成分进行了全面评估，以确定重塑的预测因子。方法和结果对近期发病的 DCM 患者进行前瞻性研究，通过心血管磁共振 (CMR) 评估心室结构和功能、细胞外容量（T1 映射）、心肌应变、心肌瘢痕（晚期钆增强）和收缩储备（多巴酚丁胺应激） . 回归分析用于评估 12 个月内 LV 射血分数 (LVEF) 变化的预测因子。我们评估了 56 名参与者（34 名 DCM 患者，中位 LVEF 43%；22 名对照）。绝对 LV 收缩储备预测 LVEF 的变化（增加 1% 与 0. 12 个月时 LVEF 增加 4%，P = 0.02）。基线心肌应变 (P = 0.39 整体纵向应变)、间质心肌纤维化 (P = 0.41)、替代心肌纤维化 (P = 0.25) 和右心室收缩储备 (P = 0.17) 与 LV 反向重构无关。收缩储备与 LV 细胞外体积分数 (r = -0.22, P = 0.23) 或基线 LVEF (r = 0.07, P = 0.62) 之间的相关性较差。男性更有可能经历不良的 LV 重构 (P = 0.01)，但年龄 (P = 0.88) 和改善疾病的心力衰竭药物（β 受体阻滞剂，P = 0.28；血管紧张素转换酶抑制剂，P = 0.92）并不能预测随访 LVEF。结论 大多数新发 DCM 患者的 LV 功能在 12 个月内显着恢复。女性的 LVEF 改善最大。通过多巴酚丁胺负荷 CMR 测量的低 LV 收缩储备似乎可以识别出 LVEF 不太可能恢复的患者。