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Title: The application of exercise stress cardiovascular magnetic resonance in patients with suspected dilated cardiomyopathy
Authors: Thu-Thao, Le 
Bryant, Jennifer Ann 
Ang, Briana Wei Yin
Pua, Chee Jian 
Su, Boyang 
Ho, Pei Yi
Lim, Shiqi
Huang, Weiting 
Lee, Phong Teck 
Tang, Hak Chiaw 
Chin, Chee Tang 
Tan, Boon Yew 
Cook, Stuart Alexander
Chin, Calvin Woon-Loong 
Keywords: Science & Technology
Life Sciences & Biomedicine
Cardiac & Cardiovascular Systems
Radiology, Nuclear Medicine & Medical Imaging
Cardiovascular System & Cardiology
Cardiovascular magnetic resonance
Supine bike ergometer
Exercise induced cardiac remodeling
Dilated cardiomyopathy
Issue Date: 3-Feb-2020
Publisher: BMC
Citation: Thu-Thao, Le, Bryant, Jennifer Ann, Ang, Briana Wei Yin, Pua, Chee Jian, Su, Boyang, Ho, Pei Yi, Lim, Shiqi, Huang, Weiting, Lee, Phong Teck, Tang, Hak Chiaw, Chin, Chee Tang, Tan, Boon Yew, Cook, Stuart Alexander, Chin, Calvin Woon-Loong (2020-02-03). The application of exercise stress cardiovascular magnetic resonance in patients with suspected dilated cardiomyopathy. JOURNAL OF CARDIOVASCULAR MAGNETIC RESONANCE 22 (1). ScholarBank@NUS Repository.
Abstract: Objectives: The imaging features of dilated cardiomyopathy (DCM) overlap with physiological exercise-induced cardiac remodeling in active and otherwise healthy individuals. Distinguishing the two conditions is challenging. This study examined the diagnostic and prognostic roles of exercise stress imaging in asymptomatic patients with suspected DCM. Methods: Exercise stress cardiovascular magnetic resonance (CMR) was performed in 60 asymptomatic patients with suspected DCM (dilated left ventricle and/or impaired systolic function on CMR), who also underwent DNA sequencing for DCM-causing genetic variants. Confirmed DCM was defined as genotype- and phenotype-positive (G+P+). Another 100 healthy subjects were recruited to establish normal exercise capacities (peak exercise cardiac index; PeakCI). The primary outcome was a composite of all-cause mortality, cardiac decompensation and ventricular arrhythmic events. Results: No patients with confirmed G+P+ DCM had PeakCI exceeding the 35th percentile specific for age and sex. Applying this threshold in G-P+ patients, those with PeakCI below 35th percentile had characteristics similar to confirmed DCM while patients with higher PeakCI were younger, more active and higher longitudinal strain. Adverse cardiovascular events occurred only in patients with low exercise capacity (P = 0.004). Conclusions: In individuals with suspected DCM, exercise stress CMR demonstrates diagnostic and prognostic potential in distinguishing between pathological DCM and physiological exercise-induced cardiac remodeling.
ISSN: 1097-6647
DOI: 10.1186/s12968-020-0598-4
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