Outcome in Dilated Cardiomyopathy Related to the Extent, Location, and Pattern of Late Gadolinium Enhancement

Halliday, Brian P; Baksi, A. John; Gulati, Ankur; Ali, Aamir; Newsome, Simon; İzgi, Cemil; Aržanauskaitė, Monika; Lota, Amrit; Tayal, Upasana; Vassiliou, Vassilios; Gregson, John; Alpendurada, Francisco; Frenneaux, Michael; Cook, Stuart A.; Cleland, John G.F.; Pennell, Dudley J.; Prasad, Sanjay K.

doi:10.1016/j.jcmg.2018.07.015

Cited by 226 publications

(197 citation statements)

References 21 publications

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“…remarkably similar incidence of LGE at NIDCM presentation (35%) to the vast literature on established NIDCM (12)(13)(14). This essentially represents "pre-diagnosis" fibrosis highlighting the significant duration of pre-clinical disease in NIDCM and providing impetus for study of It is increasingly recognised that myocardial scar induced re-entry arrhythmias make up the majority of VA in the cardiomyopathic heart (26,27).…”

Section: Accepted Manuscriptmentioning

confidence: 69%

“…In the largest study to date, Halliday et al reported a remarkably similar prevalence of LGE of 34.3% (14). This study of 874 patients with NIDCM demonstrated that patients with myocardial fibrosis on LGE are more likely to have significant VA events and death (14). The same group prospectively studied patients with NIDCM with an LVEF 40%…”

Section: Accepted Manuscriptmentioning

confidence: 96%

See 1 more Smart Citation

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

Raman

Nucifora

Leong

et al. 2019

International Journal of Cardiology

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Section: Accepted Manuscriptmentioning

confidence: 69%

Section: Accepted Manuscriptmentioning

confidence: 96%

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

Raman

Nucifora

Leong

et al. 2019

International Journal of Cardiology

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“…Two studies were then excluded because of repetition of cohort, 7,15 and a further 16 studies were excluded because of lack of raw data or otherwise ineligible comparison of study design with selection criteria. Finally, seven studies 8,9,[12][13][14]16,17 enrolling 1827 patients were included for the meta-analysis. Figure 1 provides further details regarding the identification and selection process.…”

Section: Study Inclusion and Exclusionmentioning

confidence: 99%

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

et al. 2020

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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.

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“…A recent observational study49 suggests that among patients with DCM and LVEF<35%, ICD implantation was associated with a reduction in mortality only among those with LGE. An even more recent publication following 874 patients over a median of 4.9 years highlighted the increased risk of septal and lateral mid-wall LGE but indicated that the incremental value of LGE extent beyond the presence of LGE was small 50. Randomised trials are needed to assess whether ICD provides prognostic advantage to patients with DCM and severe LVSD but no LGE; if no benefit is found and only those with LVEF<35% and LGE were given an ICD, the number needed to treat to save one life would be significantly reduced.…”

Section: Future Directionsmentioning

confidence: 99%

Towards cardiac MRI based risk stratification in idiopathic dilated cardiomyopathy

Brown

Miller

Marco

et al. 2018

Heart

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Sudden cardiac death (SCD) secondary to arrhythmia remains a risk in those with dilated cardiomyopathy (DCM), an implantable cardiac defibrillator (ICD) is an effective strategy to prevent SCD. Current guidelines recommend selection for ICD based on ejection fraction (EF) less than 35%, however, most SCD occurs in those with EF>35%. Although meta-analysis has demonstrated a survival benefit for primary prevention ICD in DCM, no randomised trial has shown a significant reduction in overall mortality including the most recent ‘Danish Study to Assess the Efficacy of ICDs in Patients With Non-Ischemic Systolic Heat Failure on Mortality’ study. Clearly, a more sophisticated selection strategy is required. Cardiac MRI (CMR) is an ideal non-invasive imaging technique which allows calculation of EF as well as tissue characterisation with gadolinium contrast, parametric mapping and feature tracking. Late gadolinium enhancement detects mid-wall fibrosis in approximately 30% of those with DCM, three meta-analyses have demonstrated an association between fibrosis in DCM and SCD, and those without fibrosis are at low risk of SCD. T1 mapping and extracellular volume (ECV) calculation are methods of demonstrating diffuse fibrosis in the myocardium. Raised ECV and native T1 have been associated with worse outcomes but the relationship to SCD has not been well studied. Undoubtedly, more research is required but CMR has several tools which offer incremental value above EF to improve risk stratification and consequent outcomes and resource utilisation in those with DCM.

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Outcome in Dilated Cardiomyopathy Related to the Extent, Location, and Pattern of Late Gadolinium Enhancement

Abstract: In DCM, the presence of septal LGE is associated with a large increase in the risk of death and SCD events, even when the extent is small. SCD risk is greatest with concomitant septal and free-wall LGE. The incremental value of LGE extent beyond small amounts and LGE pattern is limited.

Cited by 226 publications

References 21 publications

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

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

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

Towards cardiac MRI based risk stratification in idiopathic dilated cardiomyopathy

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