Key result
Late gadolinium enhancement on cardiac MRI independently predicted sudden cardiac death events in nonischemic dilated cardiomyopathy (HR 1.87; 95% CI 1.07-3.27; P=0.03).
Why the study?
Sudden cardiac death is a leading cause of death in nonischemic DCM, but clinical risk stratification of SCD events remains challenging.
Does myocardial tissue characterization with cardiac MRI predict sudden cardiac death events in adults with nonischemic dilated cardiomyopathy?
Cohort (n=858)
No
Does myocardial tissue characterization with cardiac MRI predict sudden cardiac death events in adults with nonischemic dilated cardiomyopathy?
Hazard Ratio: 1.87 (95% CI 1.07–3.27)
p-value: p=0.03
Cardiac MRI-derived myocardial tissue characteristics, including late gadolinium enhancement, native T1, and extracellular volume fraction, independently predict sudden cardiac death events in patients with nonischemic dilated cardiomyopathy.
CMR tissue characterization may refine SCD risk stratification in nonischemic dilated cardiomyopathy; leaves open need for prospective validation before changing practice.
Background Sudden cardiac death (SCD) is one of the leading causes of death in individuals with nonischemic dilated cardiomyopathy (DCM). However, the risk stratification of SCD events remains challenging in clinical practice. Purpose To determine whether myocardial tissue characterization with cardiac MRI could be used to predict SCD events and to explore a SCD stratification algorithm in nonischemic DCM. Materials and Methods In this prospective single-center study, adults with nonischemic DCM who underwent cardiac MRI between June 2012 and August 2020 were enrolled. SCD-related events included SCD, appropriate implantable cardioverter-defibrillator shock, and resuscitation after cardiac arrest. Competing risk regression analysis and Kaplan-Meier analysis were performed to identify the association of myocardial tissue characterization with outcomes. Results Among the 858 participants (mean age, 48 years; age range, 18–83 years; 603 men), 70 (8%) participants experienced SCD-related events during a median follow-up of 33.0 months. In multivariable competing risk analysis, late gadolinium enhancement (LGE) (hazard ratio [HR], 1.87; 95% CI: 1.07, 3.27; P = .03), native T1 (per 10-msec increase: HR, 1.07; 95% CI: 1.04, 1.11; P < .001), and extracellular volume fraction (per 3% increase: HR, 1.26; 95% CI: 1.11, 1.44; P < .001) were independent predictors of SCD-related events after adjustment of systolic blood pressure, atrial fibrillation, and left ventricular ejection fraction. An SCD risk stratification category was developed with a combination of native T1 and LGE. Participants with a native T1 value 4 or more SDs above the mean (1382 msec) had the highest annual SCD-related events rate of 9.3%, and participants with a native T1 value 2 SDs below the mean (1292 msec) and negative LGE had the lowest rate of 0.6%. This category showed good prediction ability (C statistic = 0.74) and could be used to discriminate SCD risk and competing heart failure risk. Conclusion Myocardial tissue characteristics derived from cardiac MRI were independent predictors of sudden cardiac death (SCD)–related events in individuals with nonischemic dilated cardiomyopathy and could be used to stratify participants according to different SCD risk categories. Clinical trial registration no. ChiCTR1800017058 © RSNA, 2023 Supplemental material is available for this article. See also the editorial by Sakuma in this issue.
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Li et al. (2023) conducted a cohort in nonischemic dilated cardiomyopathy (n=858). Late gadolinium enhancement (LGE) on cardiac MRI was evaluated on SCD-related events (SCD, appropriate implantable cardioverter-defibrillator shock, and resuscitation after cardiac arrest) (HR 1.87, 95% CI 1.07-3.27, p=0.03). Late gadolinium enhancement on cardiac MRI independently predicted sudden cardiac death events in nonischemic dilated cardiomyopathy (HR 1.87; 95% CI 1.07-3.27; P=0.03).
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