Multi-slice computed tomography in dilated cardiomyopathy: comparison with myocardial biopsy, diagnostic and prognostic value

Abstract

Purpose: To study diagnostic and prognostic value of Multislice Computed Tomography (MSCT) in patients with dilated cardiomyopathy in comparison with myocardial biopsy.Methods: 88 patients (65 men, 47.2±11.7 years) with dilated cardiomyopathy (mean left ventricle diastolic diameter 6.7±0.9 cm, LVEF 28.0±10.5%) had 320-row MSCT, in 21 patients morphological study (endomyocardial/intraoperative biopsy, autopsy or explanted heart examination) was also performed. Anti-heart antibodies were also measured as well as virus detection, EchoCG, scintigraphy (n=23), MRI (n=10), coronary angiography (n=36) were performed.Results: Areas of low contrast enhancement were found in 8 patients (9.1%, 1 point), myocardial late enhancement in 40 (45.5%): subendocardial, 16 (2 points), subepicardial, 17 (3 points), transmural, 16 (4 points). In addition, fat in the right (n=3, 3.4%) and both ventricles (n=2, 2.3%), noncompact myocardium of the left ventricle (n=16, 18.2%), myocardial late enhancement in aorta (n=1, 1.1%), coronary artery stenosis more 50% (n=10, 11.4%), vascular anomalies (n=3, 3.4%), including massive pelvic arteriovenous malformation as a cause of hypervolemic dilated cardiomyopathy were found. The sensitivity and specificity of the subepicardial/transmural enhancement for myocarditis diagnostics were 55% and 100% with biopsy and 44.9% and 84.6% with combined study, respectively. Myocarditis was diagnosed based on combined study in all patients with coronary atherosclerosis (MSCT), late subepicardial/ transmural enhancement was found in 4 cases (40%); coronary angiography has not confirmed significant stenoses in 3 patients. Different types of contrast enhancement on the scale 0-4 points correlated with: 1) morphological findings: more than 14 infiltrating cells (r=0.53, p<0.05), focal cardiosclerosis (r=0.50. p<0.05), 2) diagnostic signs: disease duration (r=-0.28, p<0.05), acute onset (r=0.36, p<0.01), relationship between disease onset and infection (r=0.30. p<0.01), CRP (r=0.25, p<0.05); 3) functional signs: NYHA class (r=0.33, p<0.001), left ventricular hypertrophy on ECG (r=0.35, p<0.01), EF (r=-0.27, p <0.05), VTI (r = -0.46, p <0.01), E/A (r=0.43, p <0.01); 4) mortality (r=0.44, p<0.001): RR of all-cause mortality was 2.43 (95% CI 1.57-3.77, p<0.01).Conclusions: MSCT in patients with dilated cardiomyopathy is a highly informative method; the late contrast enhancement correlated with myocarditis, severity of functional impairment and prognosis.