Key result
Nonischemic LGE with normal LVEF and volumes is linked to very low ~0.2% SCD risk.
Why the study?
Nonischemic patterns of late gadolinium enhancement with normal LV volumes and ejection fraction are increasingly detected on cardiovascular magnetic resonance, but their prognostic significance and management are uncertain.
Does the presence of nonischemic late gadolinium enhancement predict sudden cardiac death or mortality in patients with normal LV volumes and ejection fraction?
Cohort (n=748)
No
Does the presence of nonischemic late gadolinium enhancement predict sudden cardiac death or mortality in patients with normal LV volumes and ejection fraction?
In patients with normal LV volumes and ejection fraction, nonischemic LGE is not associated with increased sudden cardiac death or all-cause mortality, but is associated with higher rates of cardiovascular hospitalization.
Answers are grounded in this paper and cite their sources.
Nonischemic LGE does not appear to raise SCD or mortality risk in preserved LV function; leaves open its link to hospitalizations.
OBJECTIVES: This study aims to investigate the prognostic significance of late gadolinium enhancement (LGE) in patients without coronary artery disease and with normal range left ventricular (LV) volumes and ejection fraction. BACKGROUND: Nonischemic patterns of LGE with normal LV volumes and ejection fraction are increasingly detected on cardiovascular magnetic resonance, but their prognostic significance, and consequently management, is uncertain. METHODS: Patients with midwall/subepicardial LGE and normal LV volumes, wall thickness, and ejection fraction on cardiovascular magnetic resonance were enrolled and compared to a control group without LGE. The primary outcome was actual or aborted sudden cardiac death (SCD). RESULTS: Of 748 patients enrolled, 401 had LGE and 347 did not. The median age was 50 years (interquartile range: 38-61 years), LV ejection fraction 66% (interquartile range: 62%-70%), and 287 (38%) were women. Scan indications included chest pain (40%), palpitation (33%) and breathlessness (13%). No patient experienced SCD and only 1 LGE+ patient (0.13%) had an aborted SCD in the 11th follow-up year. Over a median of 4.3 years, 30 patients (4.0%) died. All-cause mortality was similar for LGE+/- patients (3.7% vs 4.3%; P = 0.71) and was associated with age (HR: 2.04 per 10 years; 95% CI: 1.46-2.79; P < 0.001). Twenty-one LGE+ and 4 LGE- patients had an unplanned cardiovascular hospital admission (HR: 7.22; 95% CI: 4.26-21.17; P < 0.0001). CONCLUSIONS: There was a low SCD risk during long-term follow-up in patients with LGE but otherwise normal LV volumes and ejection fraction. Mortality was driven by age and not LGE presence, location, or extent, although the latter was associated with greater cardiovascular hospitalization for suspected myocarditis and symptomatic ventricular tachycardia.
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Lota et al. (2021) conducted a cohort in Normal left ventricular volumes and ejection fraction without coronary artery disease (n=748). Nonischemic late gadolinium enhancement (LGE) vs. No LGE was evaluated on Actual or aborted sudden cardiac death (SCD). In patients with normal left ventricular volumes and ejection fraction, the presence of nonischemic late gadolinium enhancement was associated with a very low risk of sudden cardiac death (0.2%) over a median of 4.3 years.
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