Late gadolinium enhancement was a strong independent predictor of ventricular arrhythmias and sudden death in patients with nonischemic dilated cardiomyopathy (HR 9.7; p < 0.001).
Cohort (n=1,165)
Yes
Does a risk stratification algorithm combining LGE and LVEF strata improve the prediction of ventricular arrhythmias and sudden death compared to LVEF alone in patients with nonischemic dilated cardiomyopathy?
Integrating cardiac magnetic resonance late gadolinium enhancement with LVEF significantly improves risk stratification for ventricular arrhythmias and sudden death in nonischemic dilated cardiomyopathy, reclassifying risk for 34% of patients.
Hazard Ratio: 9.7
p-value: p=< 0.001
BACKGROUND Risk stratification for ventricular arrhythmias (VA) and sudden death in nonischemic dilated cardiomyopathy (DCM) remains suboptimal. OBJECTIVES The goal of this study was to provide an improved risk stratification algorithm for VA and sudden death in DCM. METHODS This was a retrospective cohort study of consecutive patients with DCM who underwent cardiac magnetic resonance with late gadolinium enhancement (LGE) at 2 tertiary referral centers. The combined arrhythmic endpoint included appropriate implantable cardioverter-defibrillator therapies, sustained ventricular tachycardia, resuscitated cardiac arrest, and sudden death. RESULTS In 1,165 patients with a median follow-up of 36 months, LGE was an independent and strong predictor of the arrhythmic endpoint (hazard ratio: 9.7; p 35%) was significantly superior to LVEF with the 35% cutoff (Harrell's C statistic: 0.8 vs. 0.69; area under the curve: 0.82 vs. 0.7; p 35% had significantly higher risk (annual event rate 3%; p = 0.007). CONCLUSIONS In a large cohort of patients with DCM, LGE was found to be a significant, consistent, and strong predictor of VA or sudden death. Specific high-risk LGE distributions were identified. A new clinical algorithm integrating LGE and LVEF significantly improved the risk stratification for VA and sudden death, with relevant implications for implantable cardioverter-defibrillator allocation.
“By combining two simple parameters obtained by cardiac magnetic resonance imaging, left ventricular ejection fraction and late gadolinium enhancement, they have derived an algorithm with easy clinical application that enables a much more precise risk identification than the strategy in use so far.”
Marco et al. (Tue,) conducted a cohort in Nonischemic dilated cardiomyopathy (n=1,165). Late gadolinium enhancement (LGE) vs. Absence of LGE was evaluated on Combined arrhythmic endpoint including appropriate implantable cardioverter-defibrillator therapies, sustained ventricular tachycardia, resuscitated cardiac arrest, and sudden death (HR 9.7, p=< 0.001). Late gadolinium enhancement was a strong independent predictor of ventricular arrhythmias and sudden death in patients with nonischemic dilated cardiomyopathy (HR 9.7; p < 0.001).
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