Key result
The presence of a midwall striae pattern of myocardial fibrosis independently predicted sudden cardiac arrest or appropriate implantable cardiac defibrillator therapy (HR 2.4; 95% CI 1.2-4.6; P=0.01).
Why the study?
Does the midwall striae pattern of myocardial fibrosis on LGE-CMR predict sudden cardiac arrest or appropriate ICD therapy in patients with systolic dysfunction?
Cohort (n=318)
Blinded image interpretation
Does the midwall striae pattern of myocardial fibrosis on LGE-CMR predict sudden cardiac arrest or appropriate ICD therapy in patients with systolic dysfunction?
In patients with systolic dysfunction, a midwall striae pattern of myocardial fibrosis on LGE-CMR is a strong independent predictor of sudden cardiac arrest or appropriate ICD therapy, particularly in those with LVEF >35%.
Fibrosis patterns on LGE-CMR in systolic dysfunction warrant further validation; leaves open their routine prognostic use.
BACKGROUND: Late gadolinium enhancement-cardiac magnetic resonance is increasingly performed in patients with systolic dysfunction. Numerous patterns of fibrosis are commonly reported among this population. However, the relative prevalence and prognostic significance of these findings remains uncertain. METHODS AND RESULTS: Three hundred eighteen consecutive patients referred for late gadolinium enhancement-cardiac magnetic resonance and a left ventricular ejection fraction <55% were followed up for the primary end point of sudden cardiac arrest or appropriate implantable cardiac defibrillator therapy. Late gadolinium enhancement images were blindly interpreted for the presence of 6 distinct pattern(s) of myocardial fibrosis in addition to signal threshold-based quantification of total fibrosis volume. The mean age and left ventricular ejection fraction of participants were 62.0±12.9 years and 32.6±11.9%, respectively. Any pattern of myocardial fibrosis was seen in 248 patients (78%) with ≥2 patterns present in 25% of patients. During follow-up (median of 467 days), 49 patients (15%) had a primary outcome. After adjustment for left ventricular ejection fraction, cardiomyopathy pathogenesis, and total fibrosis volume, the presence of a midwall striae pattern of fibrosis was an independent predictor of sudden cardiac arrest or appropriate implantable cardiac defibrillator therapy with a hazard ratio of 2.4 (95% confidence interval, 1.2-4.6; P=0.01); this finding is present in 30% of patients with nonischemic and 15% of patients with ischemic cardiomyopathy. Cumulative event rate was significantly higher among those with midwall striae, particularly among those with a left ventricular ejection fraction >35% (40% versus 6%; P=0.005). CONCLUSIONS: Patients with systolic dysfunction frequently demonstrate multiple patterns of myocardial fibrosis. Of these, a midwall striae pattern of fibrosis is the strongest independent predictor of sudden cardiac arrest or appropriate implantable cardiac defibrillator therapy.
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Almehmadi et al. (2014) conducted a cohort in Systolic dysfunction (n=318). Midwall striae pattern of myocardial fibrosis vs. Absence of midwall striae pattern was evaluated on Sudden cardiac arrest or appropriate implantable cardiac defibrillator therapy (HR 2.4, 95% CI 1.2-4.6, p=0.01). The presence of a midwall striae pattern of myocardial fibrosis independently predicted sudden cardiac arrest or appropriate implantable cardiac defibrillator therapy (HR 2.4; 95% CI 1.2-4.6; P=0.01).
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