Late Gadolinium Enhancement on Cardiac Magnetic Resonance Predicts Adverse Cardiovascular Outcomes in Nonischemic Cardiomyopathy

Abstract

Background LGE by CMR is a predictor of adverse cardiovascular outcomes in non-ischemic cardiomyopathy (NICM) patients. However, these findings are limited by single center studies, small sample sizes, and low event rates. We performed a meta-analysis to evaluate the prognostic role of late-gadolinium enhancement by cardiac magnetic resonance (LGE-CMR) imaging in NICM patients. Methods and Results PubMed, Cochrane CENTRAL and EMBASE were searched for studies looking at the prognostic value of LGE-CMR in NICM patients. The primary end-points included all-cause mortality, heart failure hospitalization (HFH), and a composite end point of sudden cardiac death (SCD) or aborted SCD. Pooling of odds ratios (OR) was performed using a random-effect model and annualized event rates (AER) were assessed. Data was included from 9 studies with a total of 1,488 patients and a mean follow-up of 30 months. Patients had a mean age of 52 years, 67% were male and the average LVEF was 37% on CMR. LGE was present in 38% of patients. Patients with LGE had increased overall mortality (OR 3.27, p<0.00001), HFH (OR 2.91, p=0.02), and SCD/aborted SCD (OR 5.32, p<0.00001) when compared with those without LGE. The AERs for mortality were 4.7% for LGE+ subjects vs. 1.7% for LGE- subjects (p=0.01), 5.03% vs. 1.8% for HFH (p=0.002), and 6.0% vs. 1.2% for SCD/aborted SCD (p<0.001). Conclusions LGE in NICM patients is associated with increased risk of all-cause mortality, HFH, and SCD. Detection of LGE by CMR has excellent prognostic characteristics and may help guide risk stratification and management in NICM patients.

INCA (Peru) Study: Impact of Non‐Invasive Cardiac Magnetic Resonance Assessment in the Developing World

“…This exam remains the first line exam to assess cardiac structure, but this is not sufficient to get critical information on causation, risk, therapeutic strategy, and reversibility across a wide range of diseases. CMR tissue characterization using the late gadolinium enhancement technique adds major value in many clinical scenarios, providing information that cannot be obtained any other way (myocarditis,18 amyloidosis,19 takotsubo, small apical thrombi, sarcoid20 for example), risk stratification21 and prognostic information22, 23, 24 and is becoming essential in several key clinical scenarios (chest pain, troponin rise, normal coronaries, to confirm/refute history of ischemic scarring, some cardiomyopathies). With forthcoming developments in cardiac personalized care, an appreciation of inflammation and scarring is likely to prove essential to arbitrate novel therapies.…”

Clinical profile and management of outpatients with non-ischemic and non-hypertensive systolic heart failure: Analysis of the Polish DATA-HELP registry

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An Individualized Risk Assessment of Sudden Cardiac Death in Dilation Cardiomyopathy Patients

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