Delayed enhancement cardiovascular magnetic resonance as a novel technique to predict cardiac events in dilated cardiomyopathy patients

Shimizu, Ippei; Iguchi, Nobuo; Watanabe, Hiroyuki; Umemura, Jun; Tobaru, Tetsuya; Asano, Ryuta; Misu, Kazuhiko; Nagayama, Masatoshi; Aikawa, Masanori; Funabashi, Nobusada; Komuro, Issei; Sumiyoshi, Tetsuya

doi:10.1016/j.ijcard.2008.12.189

Cited by 30 publications

(16 citation statements)

References 35 publications

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“…In addition, Looi et al 20 found numerically but not significantly higher occurrence of the composite endpoint of cardiac death/transplantation, VT/ VF, and hospitalisation in LGE positive patients. In the study by Shimizu et al, 26 only hospitalisation for heart failure was analysed, occurring significantly more frequently in patients with than without LGE (log rank, p¼0.0001).…”

Section: Results Of the Included Studiesmentioning

confidence: 99%

“…Approximately half the studies included in the meta-analysis analysed both LGE presence and extent, concluding that both help predict potential cardiac events. 15,17,21,24,26,28 For instance, Neilan et al 18 using both standard deviation-based (2 SD) and full-width of half-maximum (FWHM) methods for LGE extent quantification found a sevenfold hazard with 10% LGE extent increase in MACE outcome prediction. Because variations in definition and quantification of fibrous tissue by CMR examination among studies yielded different LGE signal intensity thresholds for anti-arrhythmia therapy institution, larger studies with consensus/standardised criteria are warranted.…”

Section: Discussionmentioning

confidence: 99%

“…There were eight studies that did not report the endpoint of all-cause mortality, 18e21,24e27 Looi et al 20 did not specifically mention sudden cardiac death cases, while Shimizu et al 26 and Gao et al 24 did not report any cases of cardiac death/transplantation, and no records of hospitalisation for heart failure were presented in studies by Leyva et al, Gao et al, or Neilan et al 16,18,24 Study design and patient baseline characteristics of the included studies are summarised in Tables 2 and 3. The mean follow-up period was 3 years (range 422e1925 days), mean age was 55AE13 years, and 70% of patients were male.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Thirdly, some valuable raw data were not provided in the included studies, and remained unavailable even after contacting several authors. Moreover, definition of LGE area differed among studies; while a signal intensity of >2 SD above mean intensity of remote normal myocardium was most often used, Shimizu et al 26 and Machii at al. 21 grouped patients according to LGE extent and Looi et al 20 did not provide a specific definition of LGE, which impairs comparability of results and increases heterogeneity.…”

Section: Limitationsmentioning

confidence: 99%

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Prognostic value of late gadolinium enhancement in dilated cardiomyopathy patients: a meta-analysis

Duan

Zhang

et al. 2015

Clinical Radiology

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Section: Results Of the Included Studiesmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

Section: Limitationsmentioning

confidence: 99%

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Prognostic value of late gadolinium enhancement in dilated cardiomyopathy patients: a meta-analysis

Duan

Zhang

et al. 2015

Clinical Radiology

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“…found an analogous prevalence of LGE (42 %) and an independent prognostic role for cardiac death, appropriate implantable cardioverter-defibrillator shock and heart failure exacerbation. Recently, other studies reported on the independent prognostic role of LGE in DCM [93][94][95][96][97][98], with some studies showing an optimal LGE threshold around 5 % of left ventricular mass for the composite end point (varying between 4.4 and 5.5 %) [94,96]. Nevertheless, these studies have provided conflicting results about the exact relationships between LGE and other clinical, electrocardiographic or functional parameters [99].…”

Section: Late Gadolinium Enhancementmentioning

confidence: 99%

Myocardial interstitial remodelling in non-ischaemic dilated cardiomyopathy: insights from cardiovascular magnetic resonance

et al. 2015

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Myocardial remodelling involves not only the myocytes, but also non-myocyte cells and the extracellular matrix, which constitutes around 6 % of the normal heart and includes fluid, collagen and glycoproteins. In non-ischaemic dilated cardiomyopathy (DCM), the cardiac interstitium increases as a result of diffuse interstitial (microscopic) fibrosis, post-necrotic replacement (macroscopic) fibrosis or myocardial oedema. The activation of the renin-angiotensin-aldosterone system is a major determinant of fibroblasts activation and collagen deposition, with the transforming growth factor β as the downstream signal mediator. Endomyocardial biopsy still represents the current reference method for interstitial and replacement myocardial fibrosis assessment, but cardiovascular magnetic resonance (CMR) allows in vivo detection of macroscopic fibrosis with post-contrast late enhancement imaging. Moreover, recent pre- and post-contrast T1 mapping techniques provide a quantitative estimation of myocardial interstitial remodelling, with potential diagnostic and prognostic clinical utility. Here, we review the pathophysiological mechanisms of myocardial interstitial remodelling in DCM, its non-invasive characterization with biomarkers and with CMR, as well as the most recent studies about their clinical utility.

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Risk Stratification in Nonischemic Dilated Cardiomyopathy Using CMR Imaging

Eichhorn,

Koeckerling,

Reddy

et al. 2024

JAMA

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ImportanceAccurate risk stratification of nonischemic dilated cardiomyopathy (NIDCM) remains challenging.ObjectiveTo evaluate the association of cardiac magnetic resonance (CMR) imaging–derived measurements with clinical outcomes in NIDCM.Data SourcesMEDLINE, Embase, Cochrane Library, and Web of Science Core Collection databases were systematically searched for articles from January 2005 to April 2023.Study SelectionProspective and retrospective nonrandomized diagnostic studies reporting on the association between CMR imaging–derived measurements and adverse clinical outcomes in NIDCM were deemed eligible.Data Extraction and SynthesisPrespecified items related to patient population, CMR imaging measurements, and clinical outcomes were extracted at the study level by 2 independent reviewers. Random-effects models were fitted using restricted maximum likelihood estimation and the method of Hartung, Knapp, Sidik, and Jonkman.Main Outcomes and MeasuresAll-cause mortality, cardiovascular mortality, arrhythmic events, heart failure events, and major adverse cardiac events (MACE).ResultsA total of 103 studies including 29 687 patients with NIDCM were analyzed. Late gadolinium enhancement (LGE) presence and extent (per 1%) were associated with higher all-cause mortality (hazard ratio [HR], 1.81 [95% CI, 1.60-2.04]; P &lt; .001 and HR, 1.07 [95% CI, 1.02-1.12]; P = .02, respectively), cardiovascular mortality (HR, 2.43 [95% CI, 2.13-2.78]; P &lt; .001 and HR, 1.15 [95% CI, 1.07-1.24]; P = .01), arrhythmic events (HR, 2.69 [95% CI, 2.20-3.30]; P &lt; .001 and HR, 1.07 [95% CI, 1.03-1.12]; P = .004) and heart failure events (HR, 1.98 [95% CI, 1.73-2.27]; P &lt; .001 and HR, 1.06 [95% CI, 1.01-1.10]; P = .02). Left ventricular ejection fraction (LVEF) (per 1%) was not associated with all-cause mortality (HR, 0.99 [95% CI, 0.97-1.02]; P = .47), cardiovascular mortality (HR, 0.97 [95% CI, 0.94-1.00]; P = .05), or arrhythmic outcomes (HR, 0.99 [95% CI, 0.97-1.01]; P = .34). Lower risks for heart failure events (HR, 0.97 [95% CI, 0.95-0.98]; P = .002) and MACE (HR, 0.98 [95% CI, 0.96-0.99]; P &lt; .001) were observed with higher LVEF. Higher native T1 relaxation times (per 10 ms) were associated with arrhythmic events (HR, 1.07 [95% CI, 1.01-1.14]; P = .04) and MACE (HR, 1.06 [95% CI, 1.01-1.11]; P = .03). Global longitudinal strain (GLS) (per 1%) was not associated with heart failure events (HR, 1.06 [95% CI, 0.95-1.18]; P = .15) or MACE (HR, 1.03 [95% CI, 0.94-1.14]; P = .43). Limited data precluded definitive analysis for native T1 relaxation times, GLS, and extracellular volume fraction (ECV) with respect to mortality outcomes.ConclusionThe presence and extent of LGE were associated with various adverse clinical outcomes, whereas LVEF was not significantly associated with mortality and arrhythmic end points in NIDCM. Risk stratification using native T1 relaxation times, extracellular volume fraction, and global longitudinal strain requires further evaluation.

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Delayed enhancement cardiovascular magnetic resonance as a novel technique to predict cardiac events in dilated cardiomyopathy patients

Cited by 30 publications

References 35 publications

Prognostic value of late gadolinium enhancement in dilated cardiomyopathy patients: a meta-analysis

Prognostic value of late gadolinium enhancement in dilated cardiomyopathy patients: a meta-analysis

Myocardial interstitial remodelling in non-ischaemic dilated cardiomyopathy: insights from cardiovascular magnetic resonance

Risk Stratification in Nonischemic Dilated Cardiomyopathy Using CMR Imaging

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