Cardiac MRI to Predict Sudden Cardiac Death Risk in Dilated                     Cardiomyopathy

Li, Yangjie; Xu, Yuanwei; Li, Weihao; Guo, Jiajun; Wan, Ke; Wang, Jie; Xu, Ziqian; Han, Yuchi; Sun, Jiayu; Chen, Yu‐Cheng

doi:10.1148/radiol.222552

Cited by 12 publications

(4 citation statements)

References 30 publications

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“…The presence of myocardial LGE as an indicator of myocardial fibrosis and its prognostic value in DCM patients has been extensively reported in previous studies. 19,35 Notably, a "heart-liver axis" has been suggested by Hernandez-Anzaldo et al, wherein cardiomyopathy could trigger hepatic inflammation through endocrine regulation. 36 Issak et al has reported a high and variable prevalence of patchy myocardial LGE in cirrhosis patients without known cardiac diseases.…”

Section: Discussionmentioning

confidence: 99%

Liver T1 Mapping Derived From Cardiac Magnetic Resonance Imaging: A Potential Prognostic Marker in Idiopathic Dilated Cardiomyopathy

Wang,

Diao,

et al. 2024

Magnetic Resonance Imaging

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BackgroundHepatic alterations are common aftereffects of heart failure (HF) and ventricular dysfunction. The prognostic value of liver injury markers derived from cardiac MRI studies in nonischemic dilated cardiomyopathy (DCM) patients is unclear.PurposeEvaluate the prognostic performance of liver injury markers derived from cardiac MRI studies in DCM patients.Study TypeProspective.PopulationThree hundred fifty‐six consecutive DCM patients diagnosed according to ESC guidelines (age 48.7 ± 14.2 years, males 72.6%).Field Strength/SequenceSteady‐state free precession, modified Look‐Locker inversion recovery T1 mapping and phase sensitive inversion recovery late gadolinium enhancement (LGE) sequences at 3 T.AssessmentClinical characteristics, conventional MRI parameters (ventricular volumes, function, mass), native myocardial and liver T1, liver extracellular volume (ECV), and myocardial LGE presence were assessed. Patients were followed up for a median duration of 48.3 months (interquartile range 42.0–69.9 months). Primary endpoints included HF death, sudden cardiac death, heart transplantation, and HF readmission; secondary endpoints included HF death, sudden cardiac death, and heart transplantation. Models were developed to predict endpoints and the incremental value of including liver parameters assessed.Statistical TestsOptimal cut‐off value was determined using receiver operating characteristic curve and Youden method. Survival analysis was performed using Kaplan–Meier and Cox proportional hazard. Discriminative power of models was compared using net reclassification improvement and integrated discriminatory index. P value <0.05 was considered statistically significant.Results47.2% patients reached primary endpoints; 25.8% patients reached secondary endpoints. Patients with elevated liver ECV (cut‐off 34.4%) had significantly higher risk reaching primary and secondary endpoints. Cox regression showed liver ECV was an independent prognostic predictor, and showed independent prognostic value for primary endpoints and long‐term HF readmission compared to conventional clinical and cardiac MRI parameters.Data ConclusionsLiver ECV is an independent prognostic predictor and may serve as an innovative approach for risk stratification for DCM.Evidence Level1Technical EfficacyStage 2

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Section: Discussionmentioning

confidence: 99%

Liver T1 Mapping Derived From Cardiac Magnetic Resonance Imaging: A Potential Prognostic Marker in Idiopathic Dilated Cardiomyopathy

Wang,

Diao,

et al. 2024

Magnetic Resonance Imaging

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“…44 Emerging data point to the possible role of quantitative myocardial tissue assessment with T1 mapping (used alone or in combination with LGE) in predicting ventricular arrhythmias. 45,46 An ongoing prospective study assesses the utility of CMR parameters, including LGE and T1 mapping in predicting all-cause and cardiovascular mortality, and SCD, in patients with DCM (T1-CMR, NCT02407197).…”

Section: Myocardial Fibrosismentioning

confidence: 99%

Incidence, risk assessment and prevention of sudden cardiac death in cardiomyopathies

Polovina,

Tschöpe,

Rosano

et al. 2023

European J of Heart Fail

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Cardiomyopathies are a significant contributor to cardiovascular morbidity and mortality, mainly due to the development of heart failure and increased risk of sudden cardiac death (SCD). Despite improvement in survival with contemporary treatment, SCD remains an important cause of mortality in cardiomyopathies. It occurs at a rate ranging between 0.15% and 0.7% per year (depending on the cardiomyopathy), which significantly surpasses SCD incidence in the age‐ and sex‐matched general population. The risk of SCD is affected by multiple factors including the aetiology, genetic basis, age, sex, physical exertion, the extent of myocardial disease severity, conduction system abnormalities, and electrical instability, as measured by various metrics. Over the past decades, the knowledge on the mechanisms and risk factors for SCD has substantially improved, allowing for a better‐informed risk stratification. However, unresolved issues still challenge the guidance of SCD prevention in patients with cardiomyopathies. In this review, we aim to provide an in‐depth discussion of the contemporary concepts pertinent to understanding the burden, risk assessment and prevention of SCD in cardiomyopathies (dilated, non‐dilated left ventricular, hypertrophic, arrhythmogenic right ventricular, and restrictive). The review first focuses on SCD incidence in cardiomyopathies and then summarizes established and emerging risk factors for life‐threatening arrhythmias/SCD. Finally, it discusses validated approaches to the risk assessment and evidence‐based measures for SCD prevention in cardiomyopathies, pointing to the gaps in evidence and areas of uncertainties that merit future clarification.

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“…Lastly, LGE reflects only focal fibrosis, but also some patients with diffuse interstitial fibrosis experienced VA events and SCD [77]. Therefore, additional CMR parameters could be necessary, such as T1 mapping technique.…”

Section: Limitations Of Late Gadolinium Enhancementmentioning

confidence: 99%

Cardiac Magnetic Resonance as Risk Stratification Tool in Non-Ischemic Dilated Cardiomyopathy Referred for Implantable Cardioverter Defibrillator Therapy—State of Art and Perspectives

Argentiero,

Carella,

Mandunzio

et al. 2023

JCM

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Non-ischemic dilated cardiomyopathy (DCM) is a disease characterized by left ventricular dilation and systolic dysfunction. Patients with DCM are at higher risk for ventricular arrhythmias and sudden cardiac death (SCD). According to current international guidelines, left ventricular ejection fraction (LVEF) ≤ 35% represents the main indication for prophylactic implantable cardioverter defibrillator (ICD) implantation in patients with DCM. However, LVEF lacks sensitivity and specificity as a risk marker for SCD. It has been seen that the majority of patients with DCM do not actually benefit from the ICD implantation and, on the contrary, that many patients at risk of SCD are not identified as they have preserved or mildly depressed LVEF. Therefore, the use of LVEF as unique decision parameter does not maximize the benefit of ICD therapy. Multiple risk factors used in combination could likely predict SCD risk better than any single risk parameter. Several predictors have been proposed including genetic variants, electric indexes, and volumetric parameters of LV. Cardiac magnetic resonance (CMR) can improve risk stratification thanks to tissue characterization sequences such as LGE sequence, parametric mapping, and feature tracking. This review evaluates the role of CMR as a risk stratification tool in DCM patients referred for ICD.

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Cardiac MRI to Predict Sudden Cardiac Death Risk in Dilated Cardiomyopathy

Cited by 12 publications

References 30 publications

Liver T1 Mapping Derived From Cardiac Magnetic Resonance Imaging: A Potential Prognostic Marker in Idiopathic Dilated Cardiomyopathy

Liver T1 Mapping Derived From Cardiac Magnetic Resonance Imaging: A Potential Prognostic Marker in Idiopathic Dilated Cardiomyopathy

Incidence, risk assessment and prevention of sudden cardiac death in cardiomyopathies

Cardiac Magnetic Resonance as Risk Stratification Tool in Non-Ischemic Dilated Cardiomyopathy Referred for Implantable Cardioverter Defibrillator Therapy—State of Art and Perspectives

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