The presence of late gadolinium enhancement on CMR in nonischemic cardiomyopathy predicted an eight-fold higher risk of adverse cardiac outcomes (HR 8.2; 95% CI 2.2-30.9; p=0.002).
Cohort (n=65)
Does the presence of late gadolinium enhancement on CMR predict adverse outcomes in patients with nonischemic cardiomyopathy?
The presence of late gadolinium enhancement on CMR strongly predicts adverse cardiac outcomes in patients with nonischemic cardiomyopathy and severe LV dysfunction.
Hazard Ratio: 8.2 (95% CI 2.2–30.9)
Absolute Event Rate: 44% vs 8%
p-value: p=0.002
We examined whether the presence and extent of late gadolinium enhancement (LGE) by CMR predict adverse outcomes in nonischemic cardiomyopathy (NICM) patients. Morbidity and mortality is high in NICM patients. However, the clinical course of an individual patient is unpredictable and current risk stratification approaches are limited. Cardiovascular magnetic resonance (CMR) detects myocardial fibrosis, which appears as LGE after contrast administration and may convey prognostic importance. In a prospective cohort study, 65 NICM patients with LVEF ≤35% underwent CMR before placement of an internal cardioverter defibrillator (ICD) for primary prevention of sudden cardiac death. CMRs were analyzed for the presence and extent of LGE, and for LV function, volumes, and mass. Patients were followed for an index composite endpoint of three cardiac events: hospitalization for heart failure, appropriate ICD firing, and cardiac death. 42% (n=27) of patients had CMR LGE, averaging 10±13% of LV mass. During a 17 month median follow-up, 44% (n=12) of patients with LGE had an index composite outcome event, versus only 8% (n=3) of those without LGE (p<0.001 for Kaplan-Meier survival curves). After adjustment for LV volume index and functional class, patients with LGE had an eight-fold higher risk of experiencing the primary outcome (hazard ratio 8.2, 95% CI 2.2–30.9, p=0.002). CMR LGE in NICM patients strongly predicts adverse cardiac outcomes. CMR LGE may represent the end-organ consequences of sustained adrenergic activation and adverse LV remodeling, and its identification may significantly improve risk stratification strategies in this high risk population. Predicting prognosis in nonischemic cardiomyopathy patients is challenging and current risk stratification approaches are limited. Cardiovascular magnetic resonance (CMR) detects myocardial fibrosis, which appears as late gadolinium enhancement (LGE). The presence of LGE predicts an eight-fold increased risk of an adverse cardiac outcome (HR 8.1, 95% CI 1.9–33.7, p=0.004), after controlling for baseline variables. CMR LGE may reflect the transition from compensated to decompensated state resulting from long-term stressors such as sustained adrenergic activation and/or the mechanical disadvantages caused by LV remodeling leading to increasing fibrosis. Identifying CMR LGE may significantly improve risk stratification strategies in this high risk population. Keywords: cardiomyopathy, prognosis, magnetic resonance imaging
Wu et al. (Sun,) conducted a cohort in Nonischemic cardiomyopathy (n=65). Presence of late gadolinium enhancement (LGE) by CMR vs. Absence of LGE was evaluated on Composite of hospitalization for heart failure, appropriate ICD firing, and cardiac death (HR 8.2, 95% CI 2.2-30.9, p=0.002). The presence of late gadolinium enhancement on CMR in nonischemic cardiomyopathy predicted an eight-fold higher risk of adverse cardiac outcomes (HR 8.2; 95% CI 2.2-30.9; p=0.002).