Key result
LGE on MRI linked to ~410% greater risk of life-threatening arrhythmias in cardiomyopathy patients with ICDs.
Why the study?
The study was conducted to evaluate the prognostic value of cardiac MR-LGE for predicting life-threatening arrhythmias and major adverse cardiovascular events in ICM and NICM patients with ICDs.
Does the presence of late gadolinium enhancement on cardiac MRI predict life-threatening arrhythmias and mortality in patients with ischemic or nonischemic cardiomyopathy and an ICD?
Meta-Analysis (n=3,457)
Does the presence of late gadolinium enhancement on cardiac MRI predict life-threatening arrhythmias and mortality in patients with ischemic or nonischemic cardiomyopathy and an ICD?
Effect estimate: OR 5.1 (95% CI 3.8-6.8)
The presence of late gadolinium enhancement on cardiac MRI is a strong predictor of life-threatening arrhythmias, MACE, and mortality in patients with ischemic and nonischemic cardiomyopathy who have an ICD.
Supports LGE incorporation into arrhythmia risk models for cardiomyopathy with ICD; leaves open impact on management and outcomes.
BACKGROUND: The presence of late gadolinium enhanced (LGE), which may enable better evaluation of myocardial impairment, would help predict the occurrence of life-threatening arrhythmias and major adverse cardiovascular events (MACE) in patients suffering from ischemic cardiomyopathy (ICM) and nonischemic cardiomyopathy (NICM) patients and who underwent a process of implantable cardioverter-defibrillator (ICD). PURPOSE: To evaluate the prognostic value of cardiac MR-LGE for ICM and NICM patients with ICD. STUDY TYPE: Systematic review and meta-analysis. POPULATION: A total of 33 studies of 3457 patients were included. FIELD STRENGTH: 1. 5T and 3.0T, LGE. ASSESSMENT: PubMed, Cochrane Library, EMBASE, and Web of Science were systematically searched for studies reporting LGE in ICM or NICM patients with ICD implantation with several kinds of endpoints: MACE, life-threatening arrhythmia, cardiovascular mortality, and all-cause mortality. STATISTICAL TESTS: A meta-analysis was performed using a random-effects model to calculate odds ratios or standard mean differences (SMDs) for binary and continuous data. RESULTS: MR-LGE was positive in 1923 (55.6%) of ICM and NICM patients. LGE-present patients were more likely to have life-threatening arrhythmia (odds ratio [OR]: 5.1; 95% confidence interval [CI]: 3.8-6.8), MACE (OR: 5.2; 95% CI: 3.8-6.9), cardiovascular mortality (OR: 2.4; 95% CI: 1.2-4.6), and all-cause mortality (OR: 2.1; 95% CI: 1.3-3.4) compared with those without LGE. Moreover, ICM and NICM patients with LGE both had increased life-threatening arrhythmia (OR: 4.6; 95% CI: 2.7-8.0; OR: 5.2; 95% CI: 3.6-7.8, respectively) and MACE (OR: 4.7; 95% CI: 2.8-7.9; OR: 4.7; 95% CI: 2.7-8.1, respectively). DATA CONCLUSION: The presence of MR-LGE may worsen the prognosis for adverse cardiovascular events in both ICM and NIMC patients who benefit more from ICDs. LEVEL OF EVIDENCE: 3 Technical Efficacy Stage: 3 J. Magn. Reson. Imaging 2020;51:1422-1439.
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Yue et al. (2019) conducted a meta-analysis in Ischemic and nonischemic cardiomyopathy with implantable cardioverter-defibrillators (n=3,457). Presence of late gadolinium enhancement (LGE) on cardiac MRI vs. Absence of LGE was evaluated on Life-threatening arrhythmia (OR 5.1, 95% CI 3.8-6.8). The presence of late gadolinium enhancement on cardiac MRI in patients with cardiomyopathy and an ICD was associated with increased life-threatening arrhythmias (OR 5.1; 95% CI 3.8-6.8).
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