CMR quantification of myocardial scar provides additive prognostic information in nonischemic cardiomyopathy.
JACC Cardiovasc Imaging
; 6(9): 944-54, 2013 Sep.
Article
em En
| MEDLINE
| ID: mdl-23932642
ABSTRACT
OBJECTIVES:
This study sought to determine whether the extent of late gadolinium enhancement (LGE) can provide additive prognostic information in patients with a nonischemic dilated cardiomyopathy (NIDC) with an indication for implantable cardioverter-defibrillator (ICD) therapy for the primary prevention of sudden cardiac death (SCD).BACKGROUND:
Data suggest that the presence of LGE is a strong discriminator of events in patients with NIDC. Limited data exist on the role of LGE quantification.METHODS:
The extent of LGE and clinical follow-up were assessed in 162 patients with NIDC prior to ICD insertion for primary prevention of SCD. LGE extent was quantified using both the standard deviation-based (2-SD) method and the full-width half-maximum (FWHM) method.RESULTS:
We studied 162 patients with NIDC (65% male; mean age 55 years; left ventricular ejection fraction [LVEF] 26 ± 8%) and followed up for major adverse cardiac events (MACE), including cardiovascular death and appropriate ICD therapy, for a mean of 29 ± 18 months. Annual MACE rates were substantially higher in patients with LGE (24%) than in those without LGE (2%). By univariate association, the presence and the extent of LGE demonstrated the strongest associations with MACE (LGE presence, hazard ratio [HR] 14.5 [95% confidence interval (CI) 6.1 to 32.6; p < 0.001]; LGE extent, HR 1.15 per 1% increase in volume of LGE [95% CI 1.12 to 1.18; p < 0.0001]). Multivariate analyses showed that LGE extent was the strongest predictor in the best overall model for MACE, and a 7-fold hazard was observed per 10% LGE extent after adjustments for patient age, sex, and LVEF (adjusted HR 7.61; p < 0.0001). LGE quantitation by 2-SD and FWHM both demonstrated robust prognostic association, with the highest MACE rate observed in patients with LGE involving >6.1% of LV myocardium.CONCLUSIONS:
LGE extent may provide further risk stratification in patients with NIDC with a current indication for ICD implantation for the primary prevention of SCD. Strategic guidance on ICD therapy by cardiac magnetic resonance in patients with NIDC warrants further study.Palavras-chave
CMR; EF; FWHM; ICD; LGE; MACE; NIDC; SCD; VT; cardiac magnetic resonance; ejection fraction; full-width half-maximum; implantable cardioverter-defibrillator; implantable cardioverter-defibrillators; late gadolinium enhancement; late gadolinium enhancement; major adverse cardiac events; nonischemic cardiomyopathy; nonischemic dilated cardiomyopathy; sudden cardiac death; ventricular tachycardia
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Cardiomiopatia Dilatada
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Função Ventricular Esquerda
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Cicatriz
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Imagem Cinética por Ressonância Magnética
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Miocárdio
Idioma:
En
Ano de publicação:
2013
Tipo de documento:
Article