TY - JOUR
T1 - Outcome in dilated cardiomyopathy related to the extent, location, and pattern of late gadolinium enhancement
AU - Halliday, Brian P.
AU - Baksi, A. John
AU - Gulati, Ankur
AU - Ali, Aamir
AU - Newsome, Simon
AU - Izgi, Cemil
AU - Arzanauskaite, Monika
AU - Lota, Amrit
AU - Tayal, Upasana
AU - Vassiliou, Vassilios S.
AU - Gregson, John
AU - Alpendurada, Francisco
AU - Frenneaux, Michael P.
AU - Cook, Stuart A.
AU - Cleland, John G.F.
AU - Pennell, Dudley J.
AU - Prasad, Sanjay K.
PY - 2019/8
Y1 - 2019/8
N2 - Objectives: This study sought to investigate the association between the extent, location, and pattern of late gadolinium enhancement (LGE) and outcome in a large dilated cardiomyopathy (DCM) cohort. Background: The relationship between LGE and prognosis in DCM is incompletely understood. Methods: The authors examined the association between LGE and all-cause mortality and a sudden cardiac death (SCD) composite based on the extent, location, and pattern of LGE in DCM. Results: Of 874 patients (588 men, median age 52 years) followed for a median of 4.9 years, 300 (34.3%) had nonischemic LGE. Estimated adjusted hazard ratios for patients with an LGE extent of 0 to 2.55%, 2.55% to 5.10%, and >5.10%, respectively, were 1.59 (95% confidence interval [CI]: 0.99 to 2.55), 1.56 (95% CI: 0.96 to 2.54), and 2.31 (95% CI: 1.50 to 3.55) for all-cause mortality, and 2.79 (95% CI: 1.42 to 5.49), 3.86 (95% CI: 2.09 to 7.13), and 4.87 (95% CI: 2.78 to 8.53) for the SCD endpoint. There was a marked nonlinear relationship between LGE extent and outcome such that even small amounts of LGE predicted a substantial increase in risk. The presence of septal LGE was associated with increased mortality, but SCD was most associated with the combined presence of septal and free-wall LGE. Predictive models using LGE presence and location were superior to models based on LGE extent or pattern. Conclusions: In DCM, the presence of septal LGE is associated with a large increase in the risk of death and SCD events, even when the extent is small. SCD risk is greatest with concomitant septal and free-wall LGE. The incremental value of LGE extent beyond small amounts and LGE pattern is limited.
AB - Objectives: This study sought to investigate the association between the extent, location, and pattern of late gadolinium enhancement (LGE) and outcome in a large dilated cardiomyopathy (DCM) cohort. Background: The relationship between LGE and prognosis in DCM is incompletely understood. Methods: The authors examined the association between LGE and all-cause mortality and a sudden cardiac death (SCD) composite based on the extent, location, and pattern of LGE in DCM. Results: Of 874 patients (588 men, median age 52 years) followed for a median of 4.9 years, 300 (34.3%) had nonischemic LGE. Estimated adjusted hazard ratios for patients with an LGE extent of 0 to 2.55%, 2.55% to 5.10%, and >5.10%, respectively, were 1.59 (95% confidence interval [CI]: 0.99 to 2.55), 1.56 (95% CI: 0.96 to 2.54), and 2.31 (95% CI: 1.50 to 3.55) for all-cause mortality, and 2.79 (95% CI: 1.42 to 5.49), 3.86 (95% CI: 2.09 to 7.13), and 4.87 (95% CI: 2.78 to 8.53) for the SCD endpoint. There was a marked nonlinear relationship between LGE extent and outcome such that even small amounts of LGE predicted a substantial increase in risk. The presence of septal LGE was associated with increased mortality, but SCD was most associated with the combined presence of septal and free-wall LGE. Predictive models using LGE presence and location were superior to models based on LGE extent or pattern. Conclusions: In DCM, the presence of septal LGE is associated with a large increase in the risk of death and SCD events, even when the extent is small. SCD risk is greatest with concomitant septal and free-wall LGE. The incremental value of LGE extent beyond small amounts and LGE pattern is limited.
KW - cardiovascular magnetic resonance
KW - dilated cardiomyopathy
KW - late gadolinium enhancement
UR - http://www.scopus.com/inward/record.url?scp=85060161640&partnerID=8YFLogxK
U2 - 10.1016/j.jcmg.2018.07.015
DO - 10.1016/j.jcmg.2018.07.015
M3 - Article
SN - 1936-878X
VL - 12
SP - 1645
EP - 1655
JO - JACC: Cardiovascular Imaging
JF - JACC: Cardiovascular Imaging
IS - 8 Part 2
ER -