Prognostic Benefit of Cardiac Magnetic Resonance Over Transthoracic Echocardiography for the Assessment of Ischemic and Nonischemic Dilated Cardiomyopathy Patients Referred for the Evaluation of Primary Prevention Implantable Cardioverter–Defibrillator Therapy

Abstract

S udden cardiac death (SCD) is the most common cause of cardiovascular death in ischemic cardiomyopathy (ICM) and nonischemic dilated cardiomyopathy (NIDCM) patients, averaging 300 000 deaths in the United States annually.1-6 Implantable cardioverter-defibrillator (ICD) demonstrated to be the most effective SCD prophylactic strategy adopted for both primary Background-The aim of this study was to determine the prognostic benefit of cardiac magnetic resonance (CMR) over transthoracic echocardiography (TTE) in ischemic cardiomyopathy and nonischemic dilated cardiomyopathy patients evaluated for primary prevention implantable cardioverter-defibrillator therapy. Methods and Results-We enrolled 409 consecutive ischemic and dilated cardiomyopathy patients (mean age: 64±12 years; 331 men). All patients underwent TTE and CMR, and left ventricle end-diastolic volume, left ventricle end-systolic volume, and left ventricle ejection fraction (LVEF) were evaluated. In addition, late gadolinium enhancement was also assessed. All patients were followed up for major adverse cardiac events (MACE) defined as a composite end point of long runs of nonsustained ventricular tachycardia, sustained ventricular tachycardia, aborted sudden cardiac death, or sudden cardiac death. The median follow-up was 545 days. CMR showed higher left ventricle end-diastolic volume (mean difference: 43±22.5 mL), higher left ventricle endsystolic volume (mean difference: 34±20.5 mL), and lower LVEF (mean difference: −4.9±10%) as compared to TTE (P<0.01). MACE occurred in 103 (25%) patients. Patients experiencing MACE showed higher left ventricle end-diastolic volume, higher left ventricle end-systolic volume, and lower LVEF with both imaging modalities and higher late gadolinium enhancement perpatient prevalence as compared to patients without MACE. At multivariable analysis, CMR-LVEF ≤35% (hazard ratio=2.18 [1.3-3.8]) and the presence of late gadolinium enhancement (hazard ratio=2.2 [1.4-3.6]) were independently associated with MACE (P<0.01). A model based on CMR-LVEF ≤35% or CMR-LVEF ≤35% plus late gadolinium enhancement detection showed a higher performance in the prediction of MACE as compared to TTE-LVEF resulting in net reclassification improvement of 0.468 (95% confidence interval, 0.283-0.654; P<0.001) and 0.413 (95% confidence interval, 0.23-0.63; P<0.001), respectively. Conclusions-CMR provides additional prognostic stratification as compared to TTE, which may have direct impact on the indication of implantable cardioverter-defibrillator implantation. (Circ Cardiovasc Imaging. 2016;9:e004956.

Long‐term prognostic value of combined free triiodothyronine and late gadolinium enhancement in nonischemic dilated cardiomyopathy

“…Their findings strongly suggested that clinical application of LGE has obvious advantage over LVEF in predicting arrhythmic events and SCD . More recently, the study by Pontone et al further confirmed LGE was a better independent predictor of CV events and could be used to refine risk classification . To avoid missing patients at high risk for cardiac events who cannot be identified with traditional risk factors and LGE, we added FT3 to create a simple, convenient model for predicting outcomes in patients with DCM.…”

QT-interval evaluation in primary percutaneous coronary intervention of ST-segment elevation myocardial infarction for prediction of myocardial salvage index

“…Assessing the efficacy of revascularization therapy in patients with anterior ST-segment elevation myocardial infarction (STEMI) is extremely important in order to guide subsequent management and assess prognosis. Estimation of infarct size with late gadolinium enhancement (LGE) technique and assessment of myocardial salvage index (MSI) measured by cardiac magnetic resonance (CMR) within the first week after primary percutaneous coronary intervention (pPCI) are independently related to early ST-segment resolution, adverse LV remodelling [ 1 , 2 ], major adverse cardiac events (MACE) and mortality at mid-term follow-up [ 3 , 4 ]. However, the limited availability and access to CMR creates a need for simpler methods for patient prognostication.…”

Agreement of 2D transthoracic echocardiography with cardiovascular magnetic resonance imaging after ST-elevation myocardial infarction

“…A previous study investigating 35 subjects from which 25 were patients diagnosed with dilated cardiomyopathy observed that 11 (44%) differed in LVEF class (≤35%, 35-55%, >50%) when comparing biplane 2D TTE to CMR [22]. Another study found prognostic benefit of CMR over 2D TTE when using LVEF measurements to determine clinical indication for ICD implantation [23].…”