Dong Geum Shin1, Hye-Jeong Lee2, Junbeom Park3, Jae-Sun Uhm1, Hui-Nam Pak1, Moon-Hyoung Lee1, Young Jin Kim4, Boyoung Joung5. 1. Division of Cardiology, Yonsei University College of Medicine, Seoul, Republic of Korea. 2. Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Republic of Korea. 3. Department of Cardiology, School of Medicine, Ewha Womans University College, Seoul, Republic of Korea. 4. Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Republic of Korea. Electronic address: dryj@yuhs.ac. 5. Division of Cardiology, Yonsei University College of Medicine, Seoul, Republic of Korea. Electronic address: cby6908@yuhs.ac.
Abstract
BACKGROUND: Left ventricular late gadolinium enhancement (LV-LGE) by cardiac magnetic resonance (CMR) imaging has been associated with adverse clinical outcomes in patients with non-ischemic cardiomyopathy (NICM). However, an association between the characteristics of the LGE and arrhythmic risk has not been demonstrated consistently. This study evaluated the impact of the LV-LGE characteristics on the arrhythmia risk in patients with NICM. METHODS: This study enrolled 365 consecutive patients (54±15years) with NICM who underwent CMR imaging. All patients were monitored for the following outcomes: major arrhythmic events (MA), including sustained ventricular tachycardia, an appropriate implantable cardioverter-defibrillator intervention, ventricular fibrillation and sudden cardiac death. RESULTS: During 44.3±36.4months of follow-up, 44 (12.1%) patients experienced MA. LV-LGE was observed in 40 (90.9%) and 221 (68.8%) patients with and without MA, respectively. LV-LGE was more frequently observed in the MA group (p=0.002). The age- and sex-adjusted hazard ratio (HR) of MA was increased in patients with LGE extent≥8% (HR 8.45, 95% confidence interval (CI) 2.91-24.6), and those with subendocardial (HR 6.98, 95% CI 1.74-28.0) and subepicardial LGE patterns (HR 7.2, 95% CI 1.61-35.6). In multivariable models adjusted for other clinical variables, only the subepicardial LGE pattern had 7.2 (95% CI, 1.61-32.6, p=0.01) time increase in the MA risk. CONCLUSIONS: LV-LGE in patients with NICM is not uncommon. The subepicardial pattern of the LV-LGE was an independent predictor of MA, suggesting that specific patterns of the LV-LGE are closely related to the severity of arrhythmic events.
BACKGROUND: Left ventricular late gadolinium enhancement (LV-LGE) by cardiac magnetic resonance (CMR) imaging has been associated with adverse clinical outcomes in patients with non-ischemic cardiomyopathy (NICM). However, an association between the characteristics of the LGE and arrhythmic risk has not been demonstrated consistently. This study evaluated the impact of the LV-LGE characteristics on the arrhythmia risk in patients with NICM. METHODS: This study enrolled 365 consecutive patients (54±15years) with NICM who underwent CMR imaging. All patients were monitored for the following outcomes: major arrhythmic events (MA), including sustained ventricular tachycardia, an appropriate implantable cardioverter-defibrillator intervention, ventricular fibrillation and sudden cardiac death. RESULTS: During 44.3±36.4months of follow-up, 44 (12.1%) patients experienced MA. LV-LGE was observed in 40 (90.9%) and 221 (68.8%) patients with and without MA, respectively. LV-LGE was more frequently observed in the MA group (p=0.002). The age- and sex-adjusted hazard ratio (HR) of MA was increased in patients with LGE extent≥8% (HR 8.45, 95% confidence interval (CI) 2.91-24.6), and those with subendocardial (HR 6.98, 95% CI 1.74-28.0) and subepicardial LGE patterns (HR 7.2, 95% CI 1.61-35.6). In multivariable models adjusted for other clinical variables, only the subepicardial LGE pattern had 7.2 (95% CI, 1.61-32.6, p=0.01) time increase in the MA risk. CONCLUSIONS: LV-LGE in patients with NICM is not uncommon. The subepicardial pattern of the LV-LGE was an independent predictor of MA, suggesting that specific patterns of the LV-LGE are closely related to the severity of arrhythmic events.
Authors: Subha V Raman; Michael Markl; Amit R Patel; Jennifer Bryant; Bradley D Allen; Sven Plein; Nicole Seiberlich Journal: J Cardiovasc Magn Reson Date: 2022-03-01 Impact factor: 5.364
Authors: Laura Keil; Céleste Chevalier; Paulus Kirchhof; Stefan Blankenberg; Gunnar Lund; Kai Müllerleile; Christina Magnussen Journal: Int J Mol Sci Date: 2021-07-01 Impact factor: 5.923