Prognostic Value of Late Gadolinium Enhancement for the Prediction of Cardiovascular Outcomes in Dilated Cardiomyopathy

Abstract

Background: Dilated cardiomyopathy is associated with increased risk of major cardiovascular events. Late gadolinium enhancement (LGE) cardiac magnetic resonance imaging is a unique tissue-based marker that, in single-center studies, suggests strong prognostic value. We retrospectively studied associations between LGE presence and adverse cardiovascular events in patients with dilated cardiomyopathy in a multicenter setting as part of an emerging global consortium (MINICOR [Multi-Modal International Cardiovascular Outcomes Registry]). Methods: Consecutive patients with dilated cardiomyopathy referred for cardiac magnetic resonance (2000–2017) at 12 institutions in 4 countries were studied. Using multivariable Cox proportional hazard and semiparametric Fine and Gray models, we evaluated the association between LGE and the composite primary end point of all-cause mortality, heart transplantation, or left ventricular assist device implant and a secondary arrhythmic end point of sudden cardiac death or appropriate implantable cardioverter-defibrillator shock. Results: We studied 1672 patients, mean age 56±14 years (29% female), left ventricular ejection fraction 33±11%, and 25% having New York Heart Association class III to IV; 650 patients (39%) had LGE. During 2.3 years (interquartile range, 1.0–4.3) follow-up, 160 patients experienced the primary end point, and 88 experienced the arrhythmic end point. In multivariable analyses, LGE was associated with 1.5-fold (hazard ratio, 1.45 [95% CI, 1.03–2.04]) risk of the primary end point and 1.8-fold (hazard ratio, 1.82 [95% CI, 1.20–3.06]) risk of the arrhythmic end point. Primary end point risk was increased in patients with multiple LGE patterns, although arrhythmic risk was higher among patients receiving primary prevention implantable cardioverter-defibrillator and widening QRS. Conclusions: In this large multinational study of patients with dilated cardiomyopathy, the presence of LGE showed strong prognostic value for identification of high-risk patients. Randomized controlled trials evaluating LGE-based care management strategies are warranted.

Extracellular volume is an independent predictor of arrhythmic burden in dilated cardiomyopathy

“…Several studies have reported an association between LGE and ventricular arrhythmias and SCD 2 , 15 , 16 . However, the majority of those studies stratified patients based on a binary classification into: LGE-present and LGE-absent groups, which is an oversimplification and gross underestimation of the true burden of cardiac fibrosis.…”

The Extent of Late Gadolinium Enhancement Can Predict Adverse Cardiac Outcomes in Patients with Non-Ischemic Cardiomyopathy with Reduced Left Ventricular Ejection Fraction: A Prospective Observational Study

“…Compared with the previous studies, our patients showed a higher prevalence of LGE on CMR. Generally, the prevalence of myocardial LGE in NICM patients ranges from 26% to 71% (6,7,15,16). These reports have demonstrated that considering the heterogeneity of the inclusion criteria for patient and scar pattern, such a wide kjronline.org range of reported incidence was not surprising.…”

Sudden cardiac death: epidemiology, pathogenesis and management

“…Hence, echocardigraphy is recommended for patients with suspected cardiac structural abnormality and HF [2]. Cardiac magnetic resonance (CMR) late gadolinium enhancement (LGE) allows depiction of myocardial fibrosis, a determinant of arrhythmic propensity, which has been shown to be a stronger prediction factor for ventricular arrhytmias than LV failure [49].…”