Late gadolinium enhancement confined to the right ventricular insertion point did not significantly increase the risk of adverse cardiac events compared to no LGE (HR 3.168, p=0.101).
Cohort (n=360)
Yes
Does the presence of late gadolinium enhancement at the right ventricular insertion point affect the risk of adverse cardiac events in patients with non-ischemic dilated cardiomyopathy?
LGE confined to the right ventricular insertion point in NICM patients does not significantly increase the risk of adverse cardiac events and has a better prognosis than a similar extent of LGE in the left ventricle.
Hazard Ratio: 3.168 (95% CI 0.8–12.541)
Absolute Event Rate: 32% vs 21.6%
p-value: p=0.101
INTRODUCTION: The presence of late gadolinium enhancement (LGE) at the right ventricular insertion point (RVIP) on cardiac magnetic resonance (CMR) is generally believed to be nonspecific, but the clinical implication of this unique LGE pattern in patients with non-ischemic dilated cardiomyopathy (NICM) has not been elucidated. OBJECTIVES: We investigated the prognostic significance of RVIP-LGE in NICM patients. METHODS: A total of 360 consecutive NICM patients referred for CMR (102 with no LGE, 50 with RVIP-LGE, 121 with left ventricular LV-LGE, and 87 with both an LV and RVIP-LGE) were studied. The primary endpoint was a composite of the all-cause death, hospitalization due to worsening of heart failure, and major arrhythmic events. RESULTS: During a mean follow-up of 45.2 ± 36.5 months, 149 (41.4%) patients (22 21.6% no LGE vs. 16 32.0% RVIP-LGE vs. 62 51.2% LV-LGE vs. 49 56.3% both LV and RVIP-LGE, P < 0.0001) reached the primary endpoint. A Kaplan Meier curve demonstrated that RVIP-LGE patients had an intermediate trend of an event free survival rate for the composite endpoint (log-rank P < 0.0001). In a multivariable Cox regression model, LV-LGE (P = 0.008) and both LV and RVIP-LGE (P = 0.003) were significantly associated with a worse outcome, whereas RVIP-LGE was not (P = 0.101). In addition, RVIP-LGE patients (n = 32) had a more favorable outcome compared to LV-LGE patients (n = 32) even after matching the extent of the LGE (median 3.4% interquartile range, 3.1-3.8, 8 25.0% RVIP-LGE vs. 20 62.5% LV-LGE, P = 0.002). CONCLUSIONS: LGE confined to the RVIP among NICM patients did not significantly increase the risk of adverse cardiac events, and also showed a better outcome than the same extent of LGE located in the LV. Identification of this unique LGE distribution may help refine the current risk stratification.
Yi et al. (Wed,) conducted a cohort in Non-ischemic dilated cardiomyopathy (n=360). Late gadolinium enhancement at the right ventricular insertion point (RVIP-LGE) vs. No LGE was evaluated on Composite of all-cause death, hospitalization due to worsening of heart failure, and major arrhythmic events (HR 3.168, 95% CI 0.800-12.541, p=0.101). Late gadolinium enhancement confined to the right ventricular insertion point did not significantly increase the risk of adverse cardiac events compared to no LGE (HR 3.168, p=0.101).