Long term prognostic importance of late gadolinium enhancement in first-presentation non-ischaemic dilated cardiomyopathy

Raman, K. Sree; Nucifora, Gaetano; Leong, Darryl P.; Marx, Christian; Shah, Ranjit; Woodman, Richard; Molaee, Payman; Shirazi, Mitra; McGavigan, Andrew D.; Pasquale, Carmine G. De; Selvanayagam, Joseph B.

doi:10.1016/j.ijcard.2019.01.018

Cited by 12 publications

(5 citation statements)

References 38 publications

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“…Furthermore, Lehrke et al have shown that NIDCM can be confirmed by cMRI-determined LV midwall fibrosis [23]. In our study, the incidence of LGE in NIDCM was similar with other studies [8,24] and, in addition, we demonstrated that LGE was an independent predictor of MACEs. Similarly, in patients with NIDCM, Gulati et al showed that the presence of mid-wall LGE was an independent predictor for outcome and improved risk stratification beyond LVEF [9].…”

Section: Discussionsupporting

confidence: 91%

Left Ventricular Geometry and Replacement Fibrosis Detected by cMRI Are Associated with Major Adverse Cardiovascular Events in Nonischemic Dilated Cardiomyopathy

Cojan-Minzat

Zlibut

Mureşan

et al. 2020

JCM

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To investigate the relationship between left ventricular (LV) long-axis strain (LAS) and LV sphericity index (LVSI) and outcomes in patients with nonischemic dilated cardiomyopathy (NIDCM) and myocardial replacement fibrosis confirmed by late gadolinium enhancement (LGE) using cardiac magnetic resonance imaging (cMRI), we conducted a prospective study on 178 patients (48 ± 14.4 years; 25.2% women) with first NIDCM diagnosis. The evaluation protocol included ECG monitoring, echocardiography and cMRI. LAS and LVSI were cMRI-determined. Major adverse cardiovascular events (MACEs) were defined as a composite outcome including heart failure (HF), ventricular arrhythmias (VAs) and sudden cardiac death (SCD). After a median follow-up of 17 months, patients with LGE+ had increased risk of MACEs. Kaplan-Meier curves showed significantly higher rate of MACEs in patients with LGE+ (p < 0.001), increased LVSI (p < 0.01) and decreased LAS (p < 0.001). In Cox analysis, LAS (HR = 1.32, 95%CI (1.54–9.14), p = 0.001), LVSI [HR = 1.17, 95%CI (1.45–7.19), p < 0.01] and LGE+ (HR = 1.77, 95%CI (2.79–12.51), p < 0.0001) were independent predictors for MACEs. In a 4-point risk scoring system based on LV ejection fraction (LVEF) < 30%, LGE+, LAS > −7.8% and LVSI > 0.48%, patients with 3 and 4 points had a significantly higher risk for MACEs. LAS and LVSI are independent predictors of MACEs and provide incremental value beyond LVEF and LGE+ in patients with NIDCM and myocardial fibrosis.

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Section: Discussionsupporting

confidence: 91%

Left Ventricular Geometry and Replacement Fibrosis Detected by cMRI Are Associated with Major Adverse Cardiovascular Events in Nonischemic Dilated Cardiomyopathy

Cojan-Minzat

Zlibut

Mureşan

et al. 2020

JCM

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“…(18) LGE imaging is a sensitive, speci c and reproducible method used in assessing focal myocardial brosis and predicting prognosis in patients with ischemic and nonischemic cardiomyopathies. (25)(26)(27) In this study, LGE was evident in all the patients with con rmed RHD.…”

Section: Discussionsupporting

confidence: 51%

Advanced chronic rheumatic heart disease is associated with substantial myocardial and valvular fibrosis on cardiovascular magnetic resonance

Aremu,

Samuels,

Jermy

et al. 2023

Preprint

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Rheumatic heart disease (RHD) is a major public health concern, particularly in low- and middle-income countries, with a reported 33.4 million cases globally and 319,400 annual deaths. Cardiovascular magnetic resonance (CMR) is a reliable non-invasive technique that detects fibrosis and inflammation in cardiovascular diseases. We assessed myocardial tissue characteristics in chronic RHD using multiparametric CMR. Forty-seven (47) patients with severe, advanced RHD booked for valve replacement surgery, diagnosed on echocardiography, and matched with thirty healthy controls, were scanned using a 3T Siemens Magnetom Skyra. Baseline demographic and clinical characteristics, CMR findings including late gadolinium enhancement (LGE), T1 mapping and ECV measurements were reported. Mean age of patients was 42 ± 12.8 years; 62% (39 ± 12.1 years) female. LGE CMR detected focal myocardial fibrosis in 100% of RHD patients vs. 7% of controls (p < 0.001). In all RHD patients, LGE involving all segments was observed. Patterns of LGE were linear (26%), patchy (36%) and diffuse (38%). We also report elevated mean native T1 (p < 0.004) and ECV (p < 0.001) in all RHD patients compared to controls, respectively. Myocardial fibrosis is abundant in patients with severe, chronic RHD. CMR can be utilised for non-invasive diagnosis of fibrosis and for tracking of disease progression.

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“…Thirty studies with a total of 7541 patients reported major ventricular arrhythmic events, which occurred in 810 patients (10.7%) 4 , 9 , 16 – 19 , 25 – 28 , 31 – 33 , 35 , 37 – 39 , 42 – 44 , 46 , 51 , 57 , 60 , 62 , 63 , 66 , 68 , 71 . The pooled OR and rates of major ventricular arrhythmic events were shown in Fig.…”

Section: Resultsmentioning

confidence: 99%

“…Twenty-four studies with a total of 5807 patients reported cardiovascular mortality, which occurred in 734 patients (12.6%) 9 , 10 , 17 , 21 , 29 – 31 , 33 , 35 , 37 – 40 , 43 , 44 , 48 , 51 , 57 , 58 , 62 , 63 , 66 , 68 , 71 . The pooled OR and rates of cardiovascular mortality were shown in Fig.…”

Section: Resultsmentioning

confidence: 99%

Impact of late gadolinium-enhanced cardiac MRI on arrhythmic and mortality outcomes in nonischemic dilated cardiomyopathy: updated systematic review and meta-analysis

Theerasuwipakorn,

Chokesuwattanaskul,

Phannajit

et al. 2023

Sci Rep

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Risk stratification based mainly on the impairment of left ventricular ejection fraction has limited performance in patients with nonischemic dilated cardiomyopathy (NIDCM). Evidence is rapidly growing for the impact of myocardial scar identified by late gadolinium enhancement (LGE) cardiac magnetic resonance imaging (CMR) on cardiovascular events. We aim to assess the prognostic value of LGE on long-term arrhythmic and mortality outcomes in patients with NIDCM. PubMed, Scopus, and Cochrane databases were searched from inception to January 21, 2022. Studies that included disease-specific subpopulations of NIDCM were excluded. Data were independently extracted and combined via random-effects meta-analysis using a generic inverse-variance strategy. Data from 60 studies comprising 15,217 patients were analyzed with a 3-year median follow-up. The presence of LGE was associated with major ventricular arrhythmic events (pooled OR: 3.99; 95% CI 3.08, 5.16), all-cause mortality (pooled OR: 2.14; 95% CI 1.81, 2.52), cardiovascular mortality (pooled OR 2.83; 95% CI 2.23, 3.60), and heart failure hospitalization (pooled OR: 2.53; 95% CI 1.78, 3.59). Real-world evidence suggests that the presence of LGE on CMR was a strong predictor of adverse long-term outcomes in patients with NIDCM. Scar assessment should be incorporated as a primary determinant in the patient selection criteria for primary prophylactic implantable cardioverter-defibrillator placement.

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Long term prognostic importance of late gadolinium enhancement in first-presentation non-ischaemic dilated cardiomyopathy

Abstract: Long term prognostic importance of late gadolinium enhancement in first-presentation non-ischaemic dilated cardiomyopathy. Ijca (2019),

Cited by 12 publications

References 38 publications

Left Ventricular Geometry and Replacement Fibrosis Detected by cMRI Are Associated with Major Adverse Cardiovascular Events in Nonischemic Dilated Cardiomyopathy

Left Ventricular Geometry and Replacement Fibrosis Detected by cMRI Are Associated with Major Adverse Cardiovascular Events in Nonischemic Dilated Cardiomyopathy

Advanced chronic rheumatic heart disease is associated with substantial myocardial and valvular fibrosis on cardiovascular magnetic resonance

Impact of late gadolinium-enhanced cardiac MRI on arrhythmic and mortality outcomes in nonischemic dilated cardiomyopathy: updated systematic review and meta-analysis

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