Abstract 17492: Extent and Pattern of Late Gadolinium Enhancement Predict Arrhythmic Events in Patients With Nonischemic Dilated Cardiomyopathy

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Dong Geum Shin ◽  
Hye-Jeong Lee ◽  
Junbeom Park ◽  
Young Jin Kim ◽  
Jae-Sun Uhm ◽  
...  
Keyword(s):  
Late Gadolinium Enhancement ◽  
Ventricular Arrhythmia ◽  
Dilated Cardiomyopathy ◽  
Cardiac Death ◽  
Primary Outcome ◽  
Multivariable Analysis ◽  
Gadolinium Enhancement ◽  
Nonischemic Dilated Cardiomyopathy ◽  
The Impact

Background: Late gadolinium enhancement (LGE) by cardiac MR (CMR) has been related to adverse clinical outcomes in patients with nonischemic dilated cardiomyopathy (NIDC). But, a statistically significant association between LGE and arrhythmic risk in NIDC has not been demonstrated consistently. This study evaluated the impact of the presence, location and pattern of LGE on arrhythmic risk prediction in NICM. Methods: This study included 365 patients (54±15years) with NICM who underwent CMR. The extent, location and pattern of LGE were categorized. We analyzed for the primary outcome of ventricular arrhythmia (VA) including sustained or nonsustained ventricular tachycardia (VT), appropriate implantable cardioverter-defibrillator (ICD) intervention and ventricular fibrillation (VF). Cardiac death and hospitalization for heart failure (HF) were evaluated as secondary outcomes. Results: LGE was seen in 267 (73 %) patients. During median follow-up of 44±36 months, patients with LGE had higher incidence of cardiac death (15 % vs. 2 %, p<0.001), hospitalization for HF (40 % vs. 15 %, p<0.001) and VA (14% vs. 6%, p=0.03). In multivariable analysis, the presence of LGE (HR 2.78; 95% CI 1.10-7.02; p=0.03) was the independent predictor of arrhythmias. Patients with extensive LGE had higher VA (32% vs. 10%, p<0.001) with lower cumulative survival free of VA than those without extensive LGE (p=0.001). The frequent LGE location was as follows: LV septum 64%, LV-RV junction 42% and inferior 10%. VA was lower in patients with than without localized LGE limited to LV-RV junction (21% vs. 46%, p=0.005). Interestingly, while the incidence of ventricular arrhythmia was higher in patients with transmural LGE (29% vs. 10%, p=0.003), it was lower in those with patch LGE (2% vs. 16%, p=0.02) than the other patients. Conclusions: In patients with NICM, the LGE was an independent prognostic predictor of VA. Extensive LGE and specific location of LGE was related with the arrhythmic events.

Long-term prognostic value of late gadolinium enhancement in a cohort of patients with nonischemic dilated cardiomyopathy

2014 ◽  
Vol 177 (1) ◽  
pp. 17-19 ◽  
Author(s):  
Jorge Rodríguez-Capitán ◽  
José Manuel García-Pinilla ◽  
Isabel Ruiz-Zamora ◽  
Eloy Rueda-Calle ◽  
Luis Morcillo-Hidalgo ◽  
...  
Keyword(s):  
Late Gadolinium Enhancement ◽  
Dilated Cardiomyopathy ◽  
Prognostic Value ◽  
Gadolinium Enhancement ◽  
Nonischemic Dilated Cardiomyopathy

P5275Cardiovascular magnetic resonance predictors of long term clinical outcome in myocarditis

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
F Sanguineti ◽  
P Garot ◽  
T Hovasse ◽  
T Unterseeh ◽  
X Troussier ◽  
...  
Keyword(s):  
Late Gadolinium Enhancement ◽  
Clinical Outcome ◽  
Cardiac Death ◽  
Acute Myocarditis ◽  
Adverse Clinical Outcome ◽  
Predictors Of Outcome ◽  
Gadolinium Enhancement ◽  
Potential Value

Abstract Background The natural history of acute myocarditis (AM) remains partially unknown and predictors of outcome are still debated. The study objectives were to determine the potential value of cardiovascular magnetic resonance (CMR) parameters for the long-term Major Adverse Cardiac Events (MACE) prediction in patients presenting with suspected AM. In our centre we published in 2015 a first analysis of the CMR myocarditis registry which included patients presenting with suspected AM in routine practice, clinically followed-up for 18 months (median follow up). This first analysis, in disagreement with the published data, did not find CMR predictors of MACE except for the LVEF. Purpose As in myocarditis MACE could have a gradual evolution, to confirm our initial results, the aim of this study is to reinvestigate in the same population, the potential value of CMR parameters with a longer follow-UP (median 8.34 years, interquartile range: 7.7 to 9.16 years). Methods In a single-centre longitudinal prospective study, 203 routine consecutive patients with clinical suspicion of AM and initial CMR-based diagnosis of AM (typical Late Gadolinium Enhancement, LGE) were clinically followed up. Various CMR parameters were evaluated as potential predictors of outcome. The primary endpoint was defined as the occurrence of at least one of the combined MACE: cardiac death or aborted sudden cardiac death, cardiac transplantation, sustained documented ventricular tachycardia, heart failure, recurrence of acute myocarditis, and the need for hospitalization for cardiac causes. Results The vast majority of patients (70,44%; N=143) presented with chest pain, mild to moderate troponin elevation and ST-segment or T wave abnormalities. Various CMR parameters were evaluated on initial CMR performed 3±2 days after acute clinical presentation (LV functional parameters, presence/extent of edema on T2, presence/extent of Early Gadolinium Enhancement (EGA) and extent of late gadolinium enhancement lesions). Out of the 203 patients, 35 (17.2%) experienced at least one major cardiovascular event during follow-up. Among all CMR parameters, initial alteration of LVEF was confirmed a MACE independent predictor by multivariate analysis (HR: 1.03 per 10% decrease, 95% CI: 1.01 to 1.06, p=0.04). Furthermore, at longer FU analysis, absence of EGA predicted adverse clinical outcome (HR: 2.7, 95% CI: 1.12 to 6.27, p=0.02) suggesting a potential protecting role of inflammatory response. Conclusions In routine clinical practice, in patients without severe hemodynamic compromise and a CMR-based diagnosis of AM, various CMR parameters such as the presence, extent and myocardial localisation of late gadolinium-enhanced LV myocardial lesions, were not predictive of events at long term follow up. CMR predictor of adverse clinical outcome were an initial alteration of LVEF and the absence of EGA.

P1113Patchy localisation of late gadolinium enhancement associated with ventricular arrhythmia in dilated cardiomyopathy

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
V Pooranachandran ◽  
A Mistry ◽  
Z Vali ◽  
X Li ◽  
B Sidhu ◽  
...  
Keyword(s):  
Late Gadolinium Enhancement ◽  
High Risk ◽  
Ventricular Arrhythmia ◽  
Dilated Cardiomyopathy ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Lv Function ◽  
Gadolinium Enhancement ◽  
Ventricular Ejection Fraction ◽  
Significant Difference

Abstract Funding Acknowledgements None Introduction Myocardial fibrosis detected using late gadolinium enhancement(LGE) on cardiac magnetic resonance(CMR) imaging holds prognostic value in dilated cardiomyopathy(DCM). Recent reports have demonstrated the localisation of LGE to be promising predictors of ventricular arrhythmic (VA).Aim: To determine the localisation of LGE associated with high risk of VA in DCM patients. Methods: Retrospective review of consecutive DCM patients(n = 85) implanted with an implantable cardioverter defibrillator(ICD) at a single tertiary centre between 2011-2018. All patients with insufficient follow-up data, cardiac channelopathies, primary valvular pathology and congenital heart disease were excluded from analysis(n = 11). Details of VA occurrence were obtained from medical and pacing notes. VA was defined as VA causing haemodynamic compromise or appropriate device therapy (anti-tachycardia pacing/shock). Localisation of LGE was defined as midwall, patchy, subepicardial or transmural. Left ventricular ejection fraction(LVEF) &lt;35% was defined as severely impaired function. Results:74 DCM patients implanted with an ICD were identified for analysis; LGE was observed in 18(60%) VA and 29(66%) non-VA patients(p = 0.6). There was no observed difference in mean age for patients with and without LGE (68 ± 10 vs. 65 ± 10 years,p = 0.07). A significant difference was seen between localisation and VA (p = 0.04), with patchy LGE demonstrating a higher arrhythmic risk(p = 0.005). There was no association between LVEF and LGE(p = 0.2) however, a significant difference was seen in LVEF and arrhythmic risk, with a more severely impaired LV function seen in patients without VA(p = 0.01). Conclusion:This study has demonstrated a patchy LGE localisation to be strongly associated with ventricular arrhythmia in DCM. Whilst this is a valuable tool in risk stratification, a prospective study with a larger population is required to confirm the validity of this finding. Moreover, an additional method will need to be considered to identify high risk patients without LGE. Ventricular Arrhythmia (n = 30) No Ventricular Arrhythmia (n = 44) P Value Male(%) 20(67%) 24(55%) p = 0.29 Age(Mean ± SD) 65 ± 12 65 ± 10 p = 0.36 LGE Midwall 10(56%) 24(83%) p = 0.04 Subepicardial 1(5.5%) 2(7%) p = 0.85 Transmural 1(5.5%) 2(7%) p = 0.85 Patchy 6(33%) 1(3%) p = 0.005 LVEF &lt;35% 23(77%) 42(95%) p = 0.01

Abstract 16544: Focal Fibrosis Predicts Monomorphic VT but Not Polymorphic VT or VF in Nonischemic Dilated Cardiomyopathy

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Sebastiaan R Piers ◽  
Kimberly Everaerts ◽  
Rob Van der Geest ◽  
Mark R Hazebroek ◽  
Jeroen Venlet ◽  
...  
Keyword(s):  
Ventricular Arrhythmia ◽  
Dilated Cardiomyopathy ◽  
Signal Intensity ◽  
Therapeutic Interventions ◽  
Border Zone ◽  
Icd Implantation ◽  
Nonischemic Dilated Cardiomyopathy ◽  
Focal Fibrosis ◽  
Maximal Signal Intensity

Purpose: This study aimed to analyze the effect of focal myocardial fibrosis, assessed by late gadolinium enhancement MRI (LGE-MRI), on the occurrence and type of ventricular arrhythmia in patients with nonischemic dilated cardiomyopathy (NIDCM). Methods: We included consecutive patients with NIDCM who underwent LGE-MRI before implantable cardioverter-defibrillator (ICD) implantation at two centers. LGE was defined by signal intensity ≥35% of maximal signal intensity and subdivided into core and border zone (≥50% and 35-50% of maximal signal intensity, respectively), and according to (non)basal location and transmurality. ICD recordings and 12-lead ECGs were reviewed to determine the occurrence and type of ventricular arrhythmia during follow-up. Results: Of all 87 patients (62% male, age 56±13 years, LVEF 29±12%), 55 patients (63%) had LGE (median 6.3g, IQR 0.0-13.8g). During a median follow-up of 45 months (interquartile range, 23-67), monomorphic VT occurred in 18 (21%) patients, and polymorphic VT/VF in 10 (11%). LGE predicted monomorphic VT (Log-rank, p<0.001), but not polymorphic VT/VF (Log-rank, p=0.40). The optimal cut-off value for LGE to predict monomorphic VT was 7.2 grams (area under curve 0.84). Features associated with high risk for monomorphic VT were core extent, location in basal segments and area with 51-75% transmurality. Conclusion: Focal fibrosis assessed by LGE-MRI predicts monomorphic VT, but not polymorphic VT/VF. The risk for monomorphic VT was particularly high when the LGE extent was ≥7.2 grams. The differences in underlying substrate and associated types of arrhythmia may have important implications for risk stratification and therapeutic interventions in patients with NIDCM.

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