Improved Risk Stratification for Ventricular Arrhythmias and Sudden Death in Patients With Nonischemic Dilated Cardiomyopathy

Riffel

Journal of Cardiovascular Magnetic Resonance

et al. 2021

Background Data on the prognostic value of left ventricular (LV) morphological and functional parameters including LV rotation in patients with dilated cardiomyopathy (DCM) using cardiovascular magnetic resonance (CMR) are currently scarce. In this study, we assessed the prognostic value of global longitudinal strain (GLS), global circumferential strain (GCS), global radial strain (GRS) and LV torsion using CMR feature tracking (FT). Methods CMR was performed in 350 DCM patients and 70 healthy subjects across 5 different European CMR Centers. Myocardial strain parameters were retrospectively assessed from conventional balanced steady-state free precession cine images applying FT. A combined primary endpoint (cardiac death, heart transplantation, aborted sudden cardiac death) was defined for the assessment of clinical outcome. Results GLS, GCS, GRS and LV torsion were significantly lower in DCM patients than in healthy subjects (all p < 0.001). The primary endpoint occurred in 59 (18.7%) patients [median follow-up 4.2 (2.0–5.6) years]. In the univariate analyses all strain parameters showed a significant prognostic value (p < 0.05). In the multivariate model, LV strain parameters, particularly GLS provided an incremental prognostic value compared to established CMR parameters like LV ejection fraction and late gadolinium enhancement. A scoring model including six categorical variables of standard CMR and strain parameters differentiated further risk subgroups. Conclusion LV strain assessed with CMR FT has a high prognostic value in patients with DCM, surpassing routine and dedicated functional parameters. Thus, CMR strain imaging may contribute to the improvement of risk stratification in DCM.

Section: Discussionmentioning

confidence: 99%

Myocardial mechanics in dilated cardiomyopathy: prognostic value of left ventricular torsion and strain

Riffel

Journal of Cardiovascular Magnetic Resonance

et al. 2021

Front. Cardiovasc. Med.

“…In the DANISH study's substudy, the DANISH-MRI study ( 55 ) fibrosis was shown to be an independent predictor for all-cause mortality and arrhythmic events. Similarly, an observational study conducted by Gutman et al ( 56 ) demonstrated a survival benefit associated with the implantation of an ICD for primary prevention in NICM only for patients with scar tissue on CMR, Finally, in a retrospective, very large observational study involving 1,165 patients with dilated cardiomyopathy who underwent LGE-CMR ( 57 ), LGE in CMR was found to be a very strong predictor of ventricular arrhythmias and sudden death. In addition, the presence of LGE but also specific LGE patterns (epicardial, transmural, or combined septal and free wall LGE) were found to be predictive of arrhythmic events and were considered high-risk LGE patterns.…”

Section: Clinical Applications Of Lge-cmr In Vt Ablationmentioning

confidence: 93%

Cardiac Magnetic Resonance for Ventricular Tachycardia Ablation and Risk Stratification

Roca‐Luque

Mont-Girbau

2022

Ventricular tachycardia is the most frequent cause of sudden cardiovascular death in patients with structural heart disease. Radiofrequency ablation is the treatment cornerstone in this population. Main mechanism for structural heart disease-related ventricular tachycardia is re-entry due to presence of slow conduction area within the scar tissue. Electroanatomical mapping with high density catheters can elucidate the presence of both scar (voltage maps) and slow conduction (activation maps). Despite the technological improvements recurrence rate after ventricular tachycardia ablation is high. Cardiac magnetic resonance has demonstrated to be useful to define the location of the scar tissue in endocardium, midmyocardium and/or epicardial region. Furthermore, recent studies have shown that cardiac magnetic resonance can analyse in detail the ventricular tachycardia substrate in terms of core scar and border zone tissue. This detailed tissue analysis has been proved to have good correlation with slow conduction areas and ventricular tachycardia isthmuses in electroanatomical maps. This review will provide a summary of the current role of cardiac magnetic resonance in different scenarios related with ventricular tachycardia in patients with structural heart disease, its limitations and the future perspectives.

“…The risk of adverse outcomes is also higher in patients with progression of LGE over time [43]. Considering the important prognostic role of LGE and the aforementioned limitations of LVEF, a combined algorithm has recently been proposed to enhance the identification of patients at high risk for SCD who should be considered for prophylactic ICD [42]. However, clinical guidelines are only based on LVEF [29,30].…”

Section: Dilated Cardiomyopathymentioning

confidence: 99%

“…These techniques offer promising new tools for risk stratification, but further validation is still required. The extension, localization, and pattern of LGE have also been associated with prognosis [41,42]; a higher burden of LGE, septal LGE, and multiple patterns (combined septal and free-wall, epicardial, and transmural LGE) are related to higher mortality or SCD. The risk of adverse outcomes is also higher in patients with progression of LGE over time [43].…”

Section: Dilated Cardiomyopathymentioning

confidence: 99%

Multimodality Cardiac Imaging in Cardiomyopathies: From Diagnosis to Prognosis

Casas

Rodríguez-Palomares

2022

JCM

Cardiomyopathies are a group of structural and/or functional myocardial disorders which encompasses hypertrophic, dilated, arrhythmogenic, restrictive, and other cardiomyopathies. Multimodality cardiac imaging techniques are the cornerstone of cardiomyopathy diagnosis; transthoracic echocardiography should be the first-line imaging modality due to its availability, and diagnosis should be confirmed by cardiovascular magnetic resonance, which will provide more accurate morphologic and functional information, as well as extensive tissue characterization. Multimodality cardiac imaging techniques are also essential in assessing the prognosis of patients with cardiomyopathies; left ventricular ejection fraction and late gadolinium enhancement are two of the main variables used for risk stratification, and they are incorporated into clinical practice guidelines. Finally, periodic testing with cardiac imaging techniques should also be performed due to the evolving and progressive natural history of most cardiomyopathies.