Left ventricular midwall fibrosis as a predictor of sudden cardiac death in non‐ischaemic dilated cardiomyopathy: a meta‐analysis

Abstract

Identification of patients with non-ischaemic dilated cardiomyopathy (NICM) who are at risk of sudden cardiac death (SCD) and could benefit from an implantable cardioverter defibrillator (ICD) is challenging. The study aims to systematically assess the prognostic value of left ventricular (LV) midwall late gadolinium enhancement (LGE) pattern in patients with NICM and further explore its value on predicting SCD events. The study was prospectively registered in PROPSERO (CRD42019138468). We systematically searched PubMed, Ovid Embase, Cochrane Library, Web of Science, and ClinicalTrials.gov to identify studies that evaluated the association between LV midwall LGE and clinical outcomes (all-cause mortality, cardiovascular mortality, and SCD or aborted SCD endpoint) in NICM patients. A meta-analysis was performed to determine pooled odds ratio (OR) for these adverse events. Seven studies including 1827 NICM patients over a mean follow-up duration of 36.1 ± 19.3 months were included. The presence of LV midwall LGE pattern was observed in 562 (30.8%) patients. The pooled OR was 3.37 [95% confidence intervals (CIs): 1.35-8.42] for all-cause mortality, 5.56 (95% CI: 1.23-25.22) for cardiovascular mortality, and 2.25 (95% CI: 1.16-3.16) for SCD or aborted SCD. In a subgroup analysis with mean ejection fraction cutoff point of 35%, the pooled OR for SCD or aborted SCD was 2.06 (95% CI: 1.32-3.22) for LV ejection fraction (LVEF) > 35% and 2.49 (95% CI: 1.48-4.20) for LVEF ≤ 35%. In addition, our study indicated that LV midwall LGE showed an excellent negative predictive value in identifying high-risk NICM patients and that the number needed to treat with ICD implantation in NICM patients with midwall LGE is 7. The presence of LV midwall on LGE is a significant prognosticator of adverse events in NICM patients. Additionally, patients with LV midwall LGE may be considered for ICD therapy irrespective of LVEF.

WNT/β-Catenin Signaling Promotes TGF-β-Mediated Activation of Human Cardiac Fibroblasts by Enhancing IL-11 Production

“…The prevalence of myocardial fibrosis varies depending on age and the occurrence of cardiovascular diseases. Late gadolinium-enhancement cardiac magnetic resonance identified fibrotic scars in up to one fourth of infarcted hearts [ 4 ], and in 31–38% of non-ischemic cardiomyopathy patients [ 5 , 6 ]. Furthermore, post-mortem histopathology studies reported fibrosis in every fifth heart of sudden cardiac death [ 7 ] and COVID-19 victims [ 8 ].…”

Association Between Echocardiographic Non-invasive Myocardial Work Indices and Myocardial Fibrosis in Patients With Dilated Cardiomyopathy

“…This study was conducted in a single center with a small number of samples and needs to be expanded for further study. A previous study (25) found that LV midwall LGE showed an excellent predictive value in identifying high-risk DCM patients, but the correlation between the localization of LGE (sub-endocardial, mid-segment, sub-epicardial) and myocardial work parameters in this study were not explored. In addition, the accuracy of myocardial work indices in the evaluation of therapeutic response to medications were not analyzed.…”

Left Ventricular Noncompaction in Children: The Role of Genetics, Morphology, and Function for Outcome

“…This was explained by their younger age and that the patients were clinically asymptomatic [ 63 ]. Midwall fibrosis (MWF) can be detected by LGE CMR and predicts adverse outcome in adults with non-ischemic DCM [ 64 ]. MWF was common in pediatric DCM, but was unable to predict heart failure in the pediatric study [ 65 ].…”