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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Bibliographic Details
Published in:JACC. Cardiovascular imaging Vol. 6; no. 9; p. 944
Main Authors: 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
Format: Journal Article
Language:English
Published: United States 01.09.2013
Subjects:
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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Summary: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.
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ISSN:1876-7591
1876-7591
DOI:10.1016/j.jcmg.2013.05.013