CMR quantification of myocardial scar provides additive prognostic information in nonischemic cardiomyopathy

This study sought to determine whether the extent of late gadolinium enhancement (LGE) can provide additive prognostic information in patients with a nonischemic dilated cardiomyopathy (NIDC) with an indication for implantable cardioverter-defibrillator (ICD) therapy for the primary prevention of su...

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Vydáno v:	JACC. Cardiovascular imaging Ročník 6; číslo 9; s. 944
Hlavní autoři:	Neilan, Tomas G, Coelho-Filho, Otavio R, Danik, Stephan B, Shah, Ravi V, Dodson, John A, Verdini, Daniel J, Tokuda, Michifumi, Daly, Caroline A, Tedrow, Usha B, Stevenson, William G, Jerosch-Herold, Michael, Ghoshhajra, Brian B, Kwong, Raymond Y
Médium:	Journal Article
Jazyk:	angličtina
Vydáno:	United States 01.09.2013
Témata:	Cardiomyopathy, Dilated - complications Cardiomyopathy, Dilated - diagnosis Cardiomyopathy, Dilated - physiopathology Cicatrix - complications Cicatrix - diagnosis Diagnosis, Differential Female Follow-Up Studies Humans Magnetic Resonance Imaging, Cine - methods Male Middle Aged Myocardium - pathology Prognosis Prospective Studies Ventricular Function, Left major adverse cardiac events EF ejection fraction CMR nonischemic dilated cardiomyopathy ICD LGE nonischemic cardiomyopathy sudden cardiac death implantable cardioverter-defibrillators ventricular tachycardia MACE SCD late gadolinium enhancement FWHM late gadolinium enhancement cardiac magnetic resonance NIDC VT implantable cardioverter-defibrillator full-width half-maximum
ISSN:	1876-7591, 1876-7591
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Abstract	This study sought to determine whether the extent of late gadolinium enhancement (LGE) can provide additive prognostic information in patients with a nonischemic dilated cardiomyopathy (NIDC) with an indication for implantable cardioverter-defibrillator (ICD) therapy for the primary prevention of sudden cardiac death (SCD). Data suggest that the presence of LGE is a strong discriminator of events in patients with NIDC. Limited data exist on the role of LGE quantification. The extent of LGE and clinical follow-up were assessed in 162 patients with NIDC prior to ICD insertion for primary prevention of SCD. LGE extent was quantified using both the standard deviation-based (2-SD) method and the full-width half-maximum (FWHM) method. We studied 162 patients with NIDC (65% male; mean age: 55 years; left ventricular ejection fraction [LVEF]: 26 ± 8%) and followed up for major adverse cardiac events (MACE), including cardiovascular death and appropriate ICD therapy, for a mean of 29 ± 18 months. Annual MACE rates were substantially higher in patients with LGE (24%) than in those without LGE (2%). By univariate association, the presence and the extent of LGE demonstrated the strongest associations with MACE (LGE presence, hazard ratio [HR]: 14.5 [95% confidence interval (CI): 6.1 to 32.6; p < 0.001]; LGE extent, HR: 1.15 per 1% increase in volume of LGE [95% CI: 1.12 to 1.18; p < 0.0001]). Multivariate analyses showed that LGE extent was the strongest predictor in the best overall model for MACE, and a 7-fold hazard was observed per 10% LGE extent after adjustments for patient age, sex, and LVEF (adjusted HR: 7.61; p < 0.0001). LGE quantitation by 2-SD and FWHM both demonstrated robust prognostic association, with the highest MACE rate observed in patients with LGE involving >6.1% of LV myocardium. LGE extent may provide further risk stratification in patients with NIDC with a current indication for ICD implantation for the primary prevention of SCD. Strategic guidance on ICD therapy by cardiac magnetic resonance in patients with NIDC warrants further study.
AbstractList	This study sought to determine whether the extent of late gadolinium enhancement (LGE) can provide additive prognostic information in patients with a nonischemic dilated cardiomyopathy (NIDC) with an indication for implantable cardioverter-defibrillator (ICD) therapy for the primary prevention of sudden cardiac death (SCD).OBJECTIVESThis study sought to determine whether the extent of late gadolinium enhancement (LGE) can provide additive prognostic information in patients with a nonischemic dilated cardiomyopathy (NIDC) with an indication for implantable cardioverter-defibrillator (ICD) therapy for the primary prevention of sudden cardiac death (SCD).Data suggest that the presence of LGE is a strong discriminator of events in patients with NIDC. Limited data exist on the role of LGE quantification.BACKGROUNDData suggest that the presence of LGE is a strong discriminator of events in patients with NIDC. Limited data exist on the role of LGE quantification.The extent of LGE and clinical follow-up were assessed in 162 patients with NIDC prior to ICD insertion for primary prevention of SCD. LGE extent was quantified using both the standard deviation-based (2-SD) method and the full-width half-maximum (FWHM) method.METHODSThe extent of LGE and clinical follow-up were assessed in 162 patients with NIDC prior to ICD insertion for primary prevention of SCD. LGE extent was quantified using both the standard deviation-based (2-SD) method and the full-width half-maximum (FWHM) method.We studied 162 patients with NIDC (65% male; mean age: 55 years; left ventricular ejection fraction [LVEF]: 26 ± 8%) and followed up for major adverse cardiac events (MACE), including cardiovascular death and appropriate ICD therapy, for a mean of 29 ± 18 months. Annual MACE rates were substantially higher in patients with LGE (24%) than in those without LGE (2%). By univariate association, the presence and the extent of LGE demonstrated the strongest associations with MACE (LGE presence, hazard ratio [HR]: 14.5 [95% confidence interval (CI): 6.1 to 32.6; p < 0.001]; LGE extent, HR: 1.15 per 1% increase in volume of LGE [95% CI: 1.12 to 1.18; p < 0.0001]). Multivariate analyses showed that LGE extent was the strongest predictor in the best overall model for MACE, and a 7-fold hazard was observed per 10% LGE extent after adjustments for patient age, sex, and LVEF (adjusted HR: 7.61; p < 0.0001). LGE quantitation by 2-SD and FWHM both demonstrated robust prognostic association, with the highest MACE rate observed in patients with LGE involving >6.1% of LV myocardium.RESULTSWe studied 162 patients with NIDC (65% male; mean age: 55 years; left ventricular ejection fraction [LVEF]: 26 ± 8%) and followed up for major adverse cardiac events (MACE), including cardiovascular death and appropriate ICD therapy, for a mean of 29 ± 18 months. Annual MACE rates were substantially higher in patients with LGE (24%) than in those without LGE (2%). By univariate association, the presence and the extent of LGE demonstrated the strongest associations with MACE (LGE presence, hazard ratio [HR]: 14.5 [95% confidence interval (CI): 6.1 to 32.6; p < 0.001]; LGE extent, HR: 1.15 per 1% increase in volume of LGE [95% CI: 1.12 to 1.18; p < 0.0001]). Multivariate analyses showed that LGE extent was the strongest predictor in the best overall model for MACE, and a 7-fold hazard was observed per 10% LGE extent after adjustments for patient age, sex, and LVEF (adjusted HR: 7.61; p < 0.0001). LGE quantitation by 2-SD and FWHM both demonstrated robust prognostic association, with the highest MACE rate observed in patients with LGE involving >6.1% of LV myocardium.LGE extent may provide further risk stratification in patients with NIDC with a current indication for ICD implantation for the primary prevention of SCD. Strategic guidance on ICD therapy by cardiac magnetic resonance in patients with NIDC warrants further study.CONCLUSIONSLGE extent may provide further risk stratification in patients with NIDC with a current indication for ICD implantation for the primary prevention of SCD. Strategic guidance on ICD therapy by cardiac magnetic resonance in patients with NIDC warrants further study. This study sought to determine whether the extent of late gadolinium enhancement (LGE) can provide additive prognostic information in patients with a nonischemic dilated cardiomyopathy (NIDC) with an indication for implantable cardioverter-defibrillator (ICD) therapy for the primary prevention of sudden cardiac death (SCD). Data suggest that the presence of LGE is a strong discriminator of events in patients with NIDC. Limited data exist on the role of LGE quantification. The extent of LGE and clinical follow-up were assessed in 162 patients with NIDC prior to ICD insertion for primary prevention of SCD. LGE extent was quantified using both the standard deviation-based (2-SD) method and the full-width half-maximum (FWHM) method. We studied 162 patients with NIDC (65% male; mean age: 55 years; left ventricular ejection fraction [LVEF]: 26 ± 8%) and followed up for major adverse cardiac events (MACE), including cardiovascular death and appropriate ICD therapy, for a mean of 29 ± 18 months. Annual MACE rates were substantially higher in patients with LGE (24%) than in those without LGE (2%). By univariate association, the presence and the extent of LGE demonstrated the strongest associations with MACE (LGE presence, hazard ratio [HR]: 14.5 [95% confidence interval (CI): 6.1 to 32.6; p < 0.001]; LGE extent, HR: 1.15 per 1% increase in volume of LGE [95% CI: 1.12 to 1.18; p < 0.0001]). Multivariate analyses showed that LGE extent was the strongest predictor in the best overall model for MACE, and a 7-fold hazard was observed per 10% LGE extent after adjustments for patient age, sex, and LVEF (adjusted HR: 7.61; p < 0.0001). LGE quantitation by 2-SD and FWHM both demonstrated robust prognostic association, with the highest MACE rate observed in patients with LGE involving >6.1% of LV myocardium. LGE extent may provide further risk stratification in patients with NIDC with a current indication for ICD implantation for the primary prevention of SCD. Strategic guidance on ICD therapy by cardiac magnetic resonance in patients with NIDC warrants further study.
Author	Coelho-Filho, Otavio R Stevenson, William G Jerosch-Herold, Michael Ghoshhajra, Brian B Daly, Caroline A Kwong, Raymond Y Tokuda, Michifumi Shah, Ravi V Dodson, John A Tedrow, Usha B Danik, Stephan B Verdini, Daniel J Neilan, Tomas G
Author_xml	– sequence: 1 givenname: Tomas G surname: Neilan fullname: Neilan, Tomas G organization: Non-invasive Cardiovascular Imaging Section, Cardiovascular Division, Department of Medicine and Radiology, Brigham and Women's Hospital, Boston, Massachusetts; Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts; Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts – sequence: 2 givenname: Otavio R surname: Coelho-Filho fullname: Coelho-Filho, Otavio R – sequence: 3 givenname: Stephan B surname: Danik fullname: Danik, Stephan B – sequence: 4 givenname: Ravi V surname: Shah fullname: Shah, Ravi V – sequence: 5 givenname: John A surname: Dodson fullname: Dodson, John A – sequence: 6 givenname: Daniel J surname: Verdini fullname: Verdini, Daniel J – sequence: 7 givenname: Michifumi surname: Tokuda fullname: Tokuda, Michifumi – sequence: 8 givenname: Caroline A surname: Daly fullname: Daly, Caroline A – sequence: 9 givenname: Usha B surname: Tedrow fullname: Tedrow, Usha B – sequence: 10 givenname: William G surname: Stevenson fullname: Stevenson, William G – sequence: 11 givenname: Michael surname: Jerosch-Herold fullname: Jerosch-Herold, Michael – sequence: 12 givenname: Brian B surname: Ghoshhajra fullname: Ghoshhajra, Brian B – sequence: 13 givenname: Raymond Y surname: Kwong fullname: Kwong, Raymond Y
BackLink	https://www.ncbi.nlm.nih.gov/pubmed/23932642$$D View this record in MEDLINE/PubMed
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Copyright	Copyright © 2013 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
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Keywords	major adverse cardiac events EF ejection fraction CMR nonischemic dilated cardiomyopathy ICD LGE nonischemic cardiomyopathy sudden cardiac death implantable cardioverter-defibrillators ventricular tachycardia MACE SCD late gadolinium enhancement FWHM late gadolinium enhancement cardiac magnetic resonance NIDC VT implantable cardioverter-defibrillator full-width half-maximum
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SubjectTerms	Cardiomyopathy, Dilated - complications Cardiomyopathy, Dilated - diagnosis Cardiomyopathy, Dilated - physiopathology Cicatrix - complications Cicatrix - diagnosis Diagnosis, Differential Female Follow-Up Studies Humans Magnetic Resonance Imaging, Cine - methods Male Middle Aged Myocardium - pathology Prognosis Prospective Studies Ventricular Function, Left
Title	CMR quantification of myocardial scar provides additive prognostic information in nonischemic cardiomyopathy
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