Association Between Midwall Late Gadolinium Enhancement and Sudden Cardiac Death in Patients With Dilated Cardiomyopathy and Mild and Moderate Left Ventricular Systolic Dysfunction

Halliday, Brian P; Gulati, Ankur; Ali, Aamir; Guha, Kaushik; Newsome, Simon; Aržanauskaitė, Monika; Vassiliou, Vassilios; Lota, Amrit; İzgi, Cemil; Tayal, Upasana; Khalique, Zohya; Stirrat, Colin; Auger, Dominique; Pareek, Nilesh; Ismail, Tevfik F; Rosen, Stuart D.; Vazir, Ali; Alpendurada, Francisco; Gregson, John; Frenneaux, Michael; Cowie, Martin R.; Cleland, John G.F.; Cook, Stuart A.; Pennell, Dudley J.; Prasad, Sanjay

doi:10.1161/circulationaha.116.026910

Cited by 300 publications

(239 citation statements)

References 36 publications

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“…Mid-wall LGE occurs in around 1/3 of patients with NIDCM and represents areas of replacement fibrosis, which are thought to act as substrate for re-entrant ventricular tachycardia (7). In keeping with this, mid-wall LGE predicts a 5-9 fold increased risk of SCD and malignant ventricular arrhythmias in patients with NIDCM over the following 5 years (7,8).…”

Section: Fraction (Lvef) (Hf-ref) Has Been Questioned Following the Dmentioning

confidence: 89%

Selecting Patients With Nonischemic Dilated Cardiomyopathy for ICDs

Cleland

Halliday

Prasad

2017

Journal of the American College of Cardiology

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Section: Fraction (Lvef) (Hf-ref) Has Been Questioned Following the Dmentioning

confidence: 89%

Selecting Patients With Nonischemic Dilated Cardiomyopathy for ICDs

Cleland

Halliday

Prasad

2017

Journal of the American College of Cardiology

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“…A further study21 demonstrated a significant association between MWF and all-cause mortality (p<0.001) even after adjustment for EF; 29.6% of those with fibrosis reached the arrhythmic end points of SCD or aborted SCD versus 7% of those without fibrosis (p<0.001). Recently, the question of whether LGE signifies risk in those with DCM and EF>40% was studied 26. A total of 399 patients were enrolled, 25% had MWF, mean EF was 49% and median follow-up was 4.6 years.…”

Section: The Emerging Risk Stratification Method: Late Gadolinium Enhmentioning

confidence: 99%

Towards cardiac MRI based risk stratification in idiopathic dilated cardiomyopathy

Brown

Miller

Marco

et al. 2018

Heart

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Sudden cardiac death (SCD) secondary to arrhythmia remains a risk in those with dilated cardiomyopathy (DCM), an implantable cardiac defibrillator (ICD) is an effective strategy to prevent SCD. Current guidelines recommend selection for ICD based on ejection fraction (EF) less than 35%, however, most SCD occurs in those with EF>35%. Although meta-analysis has demonstrated a survival benefit for primary prevention ICD in DCM, no randomised trial has shown a significant reduction in overall mortality including the most recent ‘Danish Study to Assess the Efficacy of ICDs in Patients With Non-Ischemic Systolic Heat Failure on Mortality’ study. Clearly, a more sophisticated selection strategy is required. Cardiac MRI (CMR) is an ideal non-invasive imaging technique which allows calculation of EF as well as tissue characterisation with gadolinium contrast, parametric mapping and feature tracking. Late gadolinium enhancement detects mid-wall fibrosis in approximately 30% of those with DCM, three meta-analyses have demonstrated an association between fibrosis in DCM and SCD, and those without fibrosis are at low risk of SCD. T1 mapping and extracellular volume (ECV) calculation are methods of demonstrating diffuse fibrosis in the myocardium. Raised ECV and native T1 have been associated with worse outcomes but the relationship to SCD has not been well studied. Undoubtedly, more research is required but CMR has several tools which offer incremental value above EF to improve risk stratification and consequent outcomes and resource utilisation in those with DCM.

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“…[25][26][27][28] Quantification of LGE can represent a wide variety of tissue processes and has emerged as a diagnostic tool in ischemic heart disease to measure areas of infarction 29 and for risk stratification in ischemic 30,31 and nonischemic heart disease. [32][33][34] Although in clinical practice decreasing cardiac enzymes and inflammatory markers are commonly interpreted as being indicative of resolving myocarditis, no cardiac imaging studies have confirmed this assumption as of today. In this study, we sought to evaluate whether absolute serum levels of routine laboratory parameters at the time of diagnosis predict persistence of LGE on CMR at 3 months and whether their decline from baseline to 3-month follow-up correlates with improvement of LGE.…”

mentioning

confidence: 99%

Cardiac Magnetic Resonance Imaging in Myocarditis Reveals Persistent Disease Activity Despite Normalization of Cardiac Enzymes and Inflammatory Parameters at 3-Month Follow-Up

Berg

Kottwitz

Baltensperger

et al. 2017

Circ: Heart Failure

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BACKGROUND:There is a major unmet need to identify high-risk patients in myocarditis. Although decreasing cardiac and inflammatory markers are commonly interpreted as resolving myocarditis, this assumption has not been confirmed as of today. We sought to evaluate whether routine laboratory parameters at diagnosis predict dynamic of late gadolinium enhancement (LGE) as persistent LGE has been shown to be a risk marker in myocarditis. METHODS AND RESULTS:Myocarditis was diagnosed based on clinical presentation, high-sensitivity troponin T, and cardiac magnetic resonance imaging, after exclusion of obstructive coronary artery disease by angiography. Cardiac magnetic resonance imaging was repeated at 3 months.LGE extent was analyzed with the software GT Volume. Change in LGE >20% was considered significant. Investigated cardiac and inflammatory markers included high-sensitivity troponin T, creatine kinase, myoglobin, N-terminal B-type natriuretic peptide, C-reactive protein, and leukocyte count. Twenty-four patients were enrolled. Absolute levels of cardiac enzymes and inflammatory markers at baseline did not predict change in LGE at 3 months. Cardiac and inflammatory markers had normalized in 21 patients (88%). LGE significantly improved in 16 patients (67%); however, it persisted to a lesser degree in 17 of them (71%) and increased in a small percentage (21%) despite normalization of cardiac enzymes.CONCLUSIONS: This is the first study reporting that cardiac enzymes and inflammatory parameters do not sufficiently reflect LGE in myocarditis. Although a majority of patients with normalizing laboratory markers experienced improved LGE, in a small percentage LGE worsened. These data suggest that cardiac magnetic resonance imaging might add value to currently existing diagnostic tools for risk assessment in myocarditis. Cardiac Magnetic Resonance Imaging in Myocarditis is a common cardiac disease of varying degree of severity. [1][2][3][4][5] Clinical presentation may range from mild symptoms to severe heart failure and ventricular arrhythmias. 6,7 Myocarditis has been reported in up to 25% of young adults presenting with sudden death. [8][9][10][11][12] As of today, there is a major unmet need to accurately diagnose patients with myocarditis and to identify individuals at highest risk for adverse cardiovascular events. One known indicator of poor outcome is persistent late gadolinium enhancement (LGE) on cardiac magnetic resonance imaging (CMR). 13,14 Although cardiac enzymes and inflammatory markers may be elevated in acute myocarditis, 3,7,15,16 their role in predicting disease progression remains unknown. Transcriptomic biomarkers derived from a single endomyocardial biopsy have recently demonstrated promising results as highly accurate diagnostic test for lymphocytic myocarditis. 17,18 However, endomyocardial biopsy is an invasive procedure with the risk of complications and the limitation of sampling error. [19][20][21][22] Furthermore, it can only be performed in experienced centers. Therefore, its use is limit...

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Association Between Midwall Late Gadolinium Enhancement and Sudden Cardiac Death in Patients With Dilated Cardiomyopathy and Mild and Moderate Left Ventricular Systolic Dysfunction

Abstract: Supplemental Digital Content is available in the text.

Cited by 300 publications

References 36 publications

Selecting Patients With Nonischemic Dilated Cardiomyopathy for ICDs

Selecting Patients With Nonischemic Dilated Cardiomyopathy for ICDs

Towards cardiac MRI based risk stratification in idiopathic dilated cardiomyopathy

Cardiac Magnetic Resonance Imaging in Myocarditis Reveals Persistent Disease Activity Despite Normalization of Cardiac Enzymes and Inflammatory Parameters at 3-Month Follow-Up

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