Key result
Late gadolinium enhancement positivity was associated with a 72% higher risk of sudden cardiac death (HR 1.72) compared to LGE negativity in patients selected for ICD and CRT implantation.
Why the study?
LGE assessed by CMR evaluates myocardial scar associated with SCD risk, but its association with SCD risk in CRT candidates needed investigation to help guide CRT-P versus CRT-D selection.
Does the presence of late gadolinium enhancement on CMR predict sudden cardiac death in patients selected for ICD and CRT implantation?
Meta-Analysis (n=2,494)
Does the presence of late gadolinium enhancement on CMR predict sudden cardiac death in patients selected for ICD and CRT implantation?
Effect estimate: HR 1.72 (95% CI 1.18-2.50)
p-value: p=<0.05
LGE-CMR positivity is associated with a significantly increased risk of sudden cardiac death in device candidates, particularly in non-ischemic patients, though CRT-induced reverse remodeling may attenuate this risk.
AIMS: Late gadolinium enhancement (LGE) assessed by cardiovascular magnetic resonance (CMR) can evaluate myocardial scar associated with a higher risk of sudden cardiac death (SCD), which can guide the selection between cardiac resynchronization therapy with or without a defibrillator (CRT-P/CRT-D). Our aim was to investigate the association between LGE and SCD risk in patients with CRT using the LGE-CMR technique. METHODS AND RESULTS: We performed a systematic literature search using four databases. The target population was CRT candidates. The primary endpoint was SCD. The risk of bias was assessed using the QUIPS tool. Fifteen eligible articles were included with a total of 2494 patients, of whom 27%, 56%, and 19% had an implantable cardioverter defibrillator (ICD), CRT-D, and CRT-P, respectively. Altogether, 54.71% of the cohort was LGE positive, who had a 72% higher risk for SCD (HR 1.72; 95% CI 1.18-2.50) compared to LGE negatives. In non-ischemic patients, the proportion of LGE positivity was 46.6%, with a significantly higher risk for SCD as compared to LGE negatives (HR 2.42; 95% CI 1.99-2.94). The subgroup of CRT-only patients showed no difference between the LGE-positive vs. negative candidates (HR 1.17; 95% CI 0.82-1.68). Comparable SCD risk was observed between articles with short- (OR 7.47; 95% CI 0.54-103.12) vs. long-term (OR 6.15; 95% CI 0.96-39.45) follow-up time. CONCLUSION: LGE-CMR positivity was associated with an increased SCD risk; however, in CRT candidates, the difference in risk reduction between LGE positive vs. negative patients was statistically not significant, suggesting a role of reverse remodeling. LGE-CMR before device implantation could be crucial in identifying high-risk patients even in non-ischemic etiology.
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Masszi et al. (2024) conducted a meta-analysis in Heart failure with reduced ejection fraction (HFrEF) eligible for ICD or CRT (n=2,494). Late gadolinium enhancement (LGE) positivity vs. LGE negativity was evaluated on Sudden cardiac death (SCD) (HR 1.72, 95% CI 1.18-2.50, p=<0.05). Late gadolinium enhancement positivity was associated with a 72% higher risk of sudden cardiac death (HR 1.72) compared to LGE negativity in patients selected for ICD and CRT implantation.
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