Late Gadolinium Enhancement and the Risk for Ventricular Arrhythmias or Sudden Death in Dilated Cardiomyopathy

Marco, Andrea Di; Anguera, Ignasi; Schmitt, Matthias; Klem, Igor; Neilan, Tomas G.; White, James A.; Šramko, Marek; Masci, Pier Giorgio; Barison, Andrea; McKenna, Peter; Mordi, Ify; Haugaa, Kristina H.; Leyva, Francisco; Capitan, J. Rodriguez; Satoh, Hiroshi; Nabeta, Takeru; Dallaglio, Paolo; Campbell, Niall; Sabaté, Xavier; Cequier, Ángel

doi:10.1016/j.jchf.2016.09.017

Cited by 278 publications

(183 citation statements)

References 49 publications

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“…The largest and most recent meta-analysis23 confirmed that in contrast to LVEF, LGE was significantly and strongly associated with the arrhythmic end point of SCD, sustained VT or appropriate ICD therapy (pooled OR 4.3, 95% CI 3.3 to 5.8, p=0.001). Moreover, the association between LGE and ventricular arrhythmias was observed both in studies with mean LVEF<35% (OR 4.2, 95% CI 2.4 to 7.2, p=<0.001) and in studies with mean LVEF>35% (OR 5.2, 95% CI 3.4 to 7.9, p=<0.001).…”

Section: The Emerging Risk Stratification Method: Late Gadolinium Enhmentioning

confidence: 97%

Towards cardiac MRI based risk stratification in idiopathic dilated cardiomyopathy

Brown

Miller

Marco

et al. 2018

Heart

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Sudden cardiac death (SCD) secondary to arrhythmia remains a risk in those with dilated cardiomyopathy (DCM), an implantable cardiac defibrillator (ICD) is an effective strategy to prevent SCD. Current guidelines recommend selection for ICD based on ejection fraction (EF) less than 35%, however, most SCD occurs in those with EF>35%. Although meta-analysis has demonstrated a survival benefit for primary prevention ICD in DCM, no randomised trial has shown a significant reduction in overall mortality including the most recent ‘Danish Study to Assess the Efficacy of ICDs in Patients With Non-Ischemic Systolic Heat Failure on Mortality’ study. Clearly, a more sophisticated selection strategy is required. Cardiac MRI (CMR) is an ideal non-invasive imaging technique which allows calculation of EF as well as tissue characterisation with gadolinium contrast, parametric mapping and feature tracking. Late gadolinium enhancement detects mid-wall fibrosis in approximately 30% of those with DCM, three meta-analyses have demonstrated an association between fibrosis in DCM and SCD, and those without fibrosis are at low risk of SCD. T1 mapping and extracellular volume (ECV) calculation are methods of demonstrating diffuse fibrosis in the myocardium. Raised ECV and native T1 have been associated with worse outcomes but the relationship to SCD has not been well studied. Undoubtedly, more research is required but CMR has several tools which offer incremental value above EF to improve risk stratification and consequent outcomes and resource utilisation in those with DCM.

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Section: The Emerging Risk Stratification Method: Late Gadolinium Enhmentioning

confidence: 97%

Towards cardiac MRI based risk stratification in idiopathic dilated cardiomyopathy

Brown

Miller

Marco

et al. 2018

Heart

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View full text Add to dashboard Cite

show abstract

“…46–49 A recent meta-analysis identified 19 studies comprising 2850 ICM and NICM patients who experienced 423 combined arrhythmic events (sudden death, aborted sudden death, VT/VF, and appropriate ICD therapy) with an annualized event rate of 5.3%. 47, 50 The pooled OR for arrhythmic events in patients with LGE above the designated study-defined thresholds was 5.62 for all patients.…”

Section: Cmr Assessment Of Myocardial Scar and Scar Heterogeneitymentioning

confidence: 99%

Sudden Cardiac Death Substrate Imaged by Magnetic Resonance Imaging

2017

Circ: Cardiovascular Imaging

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Sudden cardiac death (SCD) is a devastating event afflicting 350,000 Americans annually, despite the availability of life-saving preventive therapy, the implantable cardioverter defibrillator (ICD). SCD prevention strategies are hampered by overreliance on global left ventricular ejection fraction (LVEF) below 35% as the most important criterion to determine ICD candidacy. Annually in the U.S. alone, this results in approximately 130,000 ICD placements at a cost of over $3 billion but only a 5% incidence per year of appropriate firings. This approach further fails to identify individuals who experience the majority, as many as 80%, of SCD events, which occur in the setting of more preserved LVEF. Better risk stratification is needed to improve care and should be guided by direct pathophysiologic markers of arrhythmic substrate, such as specific LV structural abnormalities. There is an increasing body of literature to support the prognostic value of cardiac magnetic resonance imaging with late gadolinium enhancement (CMR-LGE) in phenotyping the LV to identify those at highest risk for SCD. CMR has unparalleled tissue characterization ability and provides exquisite detail about myocardial structure and composition, abnormalities of which form the direct, pathophysiologic substrate for SCD. Here we review the evolution and current state of CMR for imaging the arrhythmic substrate, both as a research tool and for clinical applications.

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“…Generally 44% (21 to 70%) of non-ischemic DCM patients have been shown to have LGE [39], so theoretically, ECV might be useful in DCM patients without LGE. In addition, in all DCM patients, remote non-LGE area ECV could provide significant additive information for risk stratification and prognostication.…”

Section: Dilated Cardiomyopathy (Dcm)mentioning

confidence: 99%

The Prognostic Role of T1 Mapping Sequences: Can T1 Mapping Parameters Have a Role in Risk Stratification?

Choi

Park

Kim

2017

Cardiovasc Imaging Asia

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Cardiovascular disease risk stratification and prognostication are very important for treatment planning. In addition, for a growing number of patients with overt symptomatic heart failure or asymptomatic but have structural heart disease, accurate risk stratification is essential. Conventional clinical cardiovascular risk factors, several biomarkers and echo-Doppler indexes are generally used to satisfy this need. However, non-invasive approaches to direct structural and tissue characterization of the myocardium have not produced satisfactory results. The recent development of the late gadolinium enhancement (LGE) imaging allows fibrosis or myocardial inflammation to be visualized. A growing body of evidence for LGEbased prognostication has been reported. However, not all patients with heart failure or at risk for it have been assessed with LGE. Moreover, the degree of diffuse fibrosis or inflammation cannot be easily quantified with LGE techniques. Recently, introduced T1 mapping-based quantification can provide the volume of extracellular space suggestive of the degree of diffuse tissue fibrosis or inflammation. Even without gadolinium contrast, native T1 values can provide quantitative information on myocardial tissue status. Here, we review current evidence for T1 mapping-based risk stratification and prognostication for various cardiac diseases that can lead to heart failure or lethal arrhythmic events.

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Late Gadolinium Enhancement and the Risk for Ventricular Arrhythmias or Sudden Death in Dilated Cardiomyopathy

Cited by 278 publications

References 49 publications

Towards cardiac MRI based risk stratification in idiopathic dilated cardiomyopathy

Towards cardiac MRI based risk stratification in idiopathic dilated cardiomyopathy

Sudden Cardiac Death Substrate Imaged by Magnetic Resonance Imaging

The Prognostic Role of T1 Mapping Sequences: Can T1 Mapping Parameters Have a Role in Risk Stratification?

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