Ana Carolina Alba1, Juan Gaztañaga2, Farid Foroutan1, Paaladinesh Thavendiranathan1, Marco Merlo3, David Alonso-Rodriguez4, Victor Vallejo-García5, Rafael Vidal-Perez6, Cecilia Corros-Vicente7, Manuel Barreiro-Pérez5, Pablo Pazos-López8, Esther Perez-David9, Steven Dykstra10, Jacqueline Flewitt10, José Ángel Pérez-Rivera11, Maria Vazquez-Caamaño12, Stuart D Katz13, Gianfranco Sinagra3, Lars Køber14, Jeanne Poole15, Heather Ross1, Michael E Farkouh1, James A White10. 1. Peter Munk Cardiac Centre, Department of Medicine, Toronto General Hospital, University Health Network, Ontario, Canada (A.C.A., F.F. P.T., H.R., M.E.F.). 2. Division of Cardiology, Department of Medicine, NYU Winthrop Hospital, Mineola, NY (J.G.). 3. Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), Universita Degli Studi di Trieste, Trieste, Italy (M.M., G.S.). 4. Department of Cardiology, Complejo Asistencial Universitario de León, Spain (D.A.-R.). 5. Department of Cardiology, Hospital Clínico Universitario de Salamanca, Spain (V.V.-G., M.B.-P.). 6. Department of Cardiology, Hospital Universitario Lucus Augusti, Lugo, Spain (R.V.-P.). 7. Department of Cardiology, Hospital Universitario Central de Asturias, Oviedo, Spain (C.C.-V.). 8. Department of Cardiology, Complejo Hospitalario Universitario de Vigo, Spain (P.P.-L.). 9. Department of Cardiology, Hospital General Universitario Gregorio Marañon, Madrid, Spain (E.P.-D.). 10. Departments of Cardiac Sciences and Diagnostic Imaging, Libin Cardiovascular Institute of Alberta, Calgary, Canada (S.D., J.F., J.A.W.). 11. Hospital Universitario de Burgos, Spain (J.A.P.-R.). 12. Hospital Povisa, Vigo, Spain (M.V.-C.). 13. NYU Langone Health, Leon H. Charney Division of Cardiology, NY (S.D.K.). 14. Rigshospitalet, Copenhagen University Hospital, Denmark (L.K.). 15. Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA (J.P.).
Abstract
BACKGROUND: Dilated cardiomyopathy is associated with increased risk of major cardiovascular events. Late gadolinium enhancement (LGE) cardiac magnetic resonance imaging is a unique tissue-based marker that, in single-center studies, suggests strong prognostic value. We retrospectively studied associations between LGE presence and adverse cardiovascular events in patients with dilated cardiomyopathy in a multicenter setting as part of an emerging global consortium (MINICOR [Multi-Modal International Cardiovascular Outcomes Registry]). METHODS: Consecutive patients with dilated cardiomyopathy referred for cardiac magnetic resonance (2000-2017) at 12 institutions in 4 countries were studied. Using multivariable Cox proportional hazard and semiparametric Fine and Gray models, we evaluated the association between LGE and the composite primary end point of all-cause mortality, heart transplantation, or left ventricular assist device implant and a secondary arrhythmic end point of sudden cardiac death or appropriate implantable cardioverter-defibrillator shock. RESULTS: We studied 1672 patients, mean age 56±14 years (29% female), left ventricular ejection fraction 33±11%, and 25% having New York Heart Association class III to IV; 650 patients (39%) had LGE. During 2.3 years (interquartile range, 1.0-4.3) follow-up, 160 patients experienced the primary end point, and 88 experienced the arrhythmic end point. In multivariable analyses, LGE was associated with 1.5-fold (hazard ratio, 1.45 [95% CI, 1.03-2.04]) risk of the primary end point and 1.8-fold (hazard ratio, 1.82 [95% CI, 1.20-3.06]) risk of the arrhythmic end point. Primary end point risk was increased in patients with multiple LGE patterns, although arrhythmic risk was higher among patients receiving primary prevention implantable cardioverter-defibrillator and widening QRS. CONCLUSIONS: In this large multinational study of patients with dilated cardiomyopathy, the presence of LGE showed strong prognostic value for identification of high-risk patients. Randomized controlled trials evaluating LGE-based care management strategies are warranted.
BACKGROUND:Dilated cardiomyopathy is associated with increased risk of major cardiovascular events. Late gadolinium enhancement (LGE) cardiac magnetic resonance imaging is a unique tissue-based marker that, in single-center studies, suggests strong prognostic value. We retrospectively studied associations between LGE presence and adverse cardiovascular events in patients with dilated cardiomyopathy in a multicenter setting as part of an emerging global consortium (MINICOR [Multi-Modal International Cardiovascular Outcomes Registry]). METHODS: Consecutive patients with dilated cardiomyopathy referred for cardiac magnetic resonance (2000-2017) at 12 institutions in 4 countries were studied. Using multivariable Cox proportional hazard and semiparametric Fine and Gray models, we evaluated the association between LGE and the composite primary end point of all-cause mortality, heart transplantation, or left ventricular assist device implant and a secondary arrhythmic end point of sudden cardiac death or appropriate implantable cardioverter-defibrillator shock. RESULTS: We studied 1672 patients, mean age 56±14 years (29% female), left ventricular ejection fraction 33±11%, and 25% having New York Heart Association class III to IV; 650 patients (39%) had LGE. During 2.3 years (interquartile range, 1.0-4.3) follow-up, 160 patients experienced the primary end point, and 88 experienced the arrhythmic end point. In multivariable analyses, LGE was associated with 1.5-fold (hazard ratio, 1.45 [95% CI, 1.03-2.04]) risk of the primary end point and 1.8-fold (hazard ratio, 1.82 [95% CI, 1.20-3.06]) risk of the arrhythmic end point. Primary end point risk was increased in patients with multiple LGE patterns, although arrhythmic risk was higher among patients receiving primary prevention implantable cardioverter-defibrillator and widening QRS. CONCLUSIONS: In this large multinational study of patients with dilated cardiomyopathy, the presence of LGE showed strong prognostic value for identification of high-risk patients. Randomized controlled trials evaluating LGE-based care management strategies are warranted.
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