Incremental value of Late Gadolinium Enhancement by Cardiac MRI in risk stratification of heart failure patients with moderate and severe LV dysfunction

Abstract

Objective This is a prospective study of patients with LVEF ≤40%, with the objective of correlating CV events to LGE detected and quantified by CMRI. Methods Heart Failure (HF) patients with LVEF <40% who underwent CMRI were included. LGE volume of ≥6% of the myocardial volume was considered significant. Data of appropriate ICD shocks, CV hospitalizations and mortality were recorded. Results There were 133 HF (72 ICM & 62 NIDCM) patients with a mean age of 54 ± 12 years, mean LVEF of 34 ± 6% and a follow up of 24 ± 3 months. Totally 46 CV events were recorded in 30 patients, 44 in LGE +ve & 2 in LGE -ve groups (HR 17.8, 95% CI-8.03-39.3, P = 0.000095). All the 7 deaths were in LGE +ve group. CV events were 22 (30.5%) in ICM group and 8 (13.1%) in NIDCM group ( p = 0.03). All the 22 ICM patients and 6 of the 8 NIDCM with CV events were LGE +ve. The distribution of CV events amongst LGE +ve and LGE -ve were 35 vs 0 (ICM) and 9 vs 2 (NIDCM); p < 0.005.CV events in LVEF ≤ 30% group, were seen in 19 (47.5%) vs 1 (5.8%) in LGE +ve vs LGE -ve and no of events were 29 vs 1 ( p = 0.003). In those with LVEF >30% the corresponding figures were 9 (22.5%) vs 1 (2.8%) and 15 vs 1 respectively ( p = 0.02). Conclusion Demonstration of significant LGE by CMRI indicates high risk occurrence of CV events (CV hospitalization, appropriate shocks and total mortality) in NIDCM & ICM patients with LVEF < 40%.

Interdisciplinary Research—Future of Cardiology

“…Late gadolinium enhancement (LGE) in cardiac MRI (CMRI ) has proven to be a reliable surrogate of myocardial scar which is the essential substrate for sudden death and worsening HF. 1, 2 Detailed imaging inputs from CMRI have helped to precisely define the endocardial and epicardial scar, assess accurately the ventricular function, and finely delineate the arrythmogenic channels in the substrate. Further it has aided substantially in prognostication in patients with substrates like hypertrophic cardiomyopathy and non-ischemic cardiomyopathy (NICM).…”

Using CMRI to Make the Unpredictable Less Hazy

“…In this cohort, 44/46 CV events were seen in patients who had LGE over the cut off level. 8 Patients presenting to ER with resuscitated cardiac arrest are a difficult substrate as many do not have easily identifiable or modifiable substrates. Data with CMI has shown that identification of scar in these patients can help to optimally use the defibrillators.…”