Outcome in Dilated Cardiomyopathy Related to the Extent, Location, and Pattern of Late Gadolinium Enhancement

Brian P. Halliday; A. John Baksi; Ankur Gulati; Aamir Ali; Simon Newsome; Cemil Izgi; Monika Arzanauskaite; Amrit Lota; Upasana Tayal; Vassilios S. Vassiliou; John Gregson; Francisco Alpendurada; Michael P. Frenneaux; Stuart A. Cook; John G.F. Cleland; Dudley J. Pennell; Sanjay K. Prasad

doi:10.1016/j.jcmg.2018.07.015

JACC: Cardiovascular Imaging

Volume 12, Issue 8 Part 2, August 2019 DOI: 10.1016/j.jcmg.2018.07.015

Outcome in Dilated Cardiomyopathy Related to the Extent, Location, and Pattern of Late Gadolinium Enhancement

Brian P. Halliday, A. John Baksi, Ankur Gulati, Aamir Ali, Simon Newsome, Cemil Izgi, Monika Arzanauskaite, Amrit Lota, Upasana Tayal, Vassilios S. Vassiliou, John Gregson, Francisco Alpendurada, Michael P. Frenneaux, Stuart A. Cook, John G.F. Cleland, Dudley J. Pennell and Sanjay K. Prasad

Author + information

vol. 12 no. 8 Part 2 1645-1655

DOI:

https://doi.org/10.1016/j.jcmg.2018.07.015

Published By:

JACC: Cardiovascular Imaging

Print ISSN:

1936-878X

Online ISSN:

1876-7591

History:

Received February 12, 2018
Revision received July 11, 2018
Accepted July 12, 2018
Published online August 5, 2019.

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2019 The Authors

Author Information

Brian P. Halliday, MBChB^a,^b,
A. John Baksi, PhD^a,^b,
Ankur Gulati, MD^a,
Aamir Ali, MBChB^a,^b,
Simon Newsome, MSc^c,
Cemil Izgi, MD^a,
Monika Arzanauskaite, MD^a,
Amrit Lota, BMBCh^a,^b,
Upasana Tayal, BMBCh^a,^b,
Vassilios S. Vassiliou, MBBS^a,^b,^d,
John Gregson, PhD^c,
Francisco Alpendurada, PhD^a,^b,
Michael P. Frenneaux, PhD^d,
Stuart A. Cook, PhD^a,^b,^e,
John G.F. Cleland, MD^b,^f,
Dudley J. Pennell, MD^a,^b,^∗ (dj.pennell{at}rbht.nhs.uk), @ImperialNHLI and
Sanjay K. Prasad, MD^a,^b

^aCardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London
^bNational Heart & Lung Institute, Imperial College, London
^cLondon School of Hygiene and Tropical Medicine, London
^dNorwich Medical School, University of East Anglia, Norwich
^eNational Heart Centre Singapore, Singapore
^fRobertson Centre for Biostatistics, University of Glasgow, Glasgow

↵∗Address for correspondence:
Dr. Dudley J. Pennell, Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, Sydney Street, London SW3 6NP, United Kingdom.

Graphical abstract

Abstract

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.

Key Words

Footnotes

The work was supported by the Cardiovascular Research Centre at Royal Brompton and Harefield NHS Foundation Trust, UK and Imperial College, London, United Kingdom. Dr. Halliday is supported by a British Heart Foundation Clinical Research Training Fellowship, United Kingdom (FS/15/29/31492). Dr. Gulati has received funding from the Coronary Artery Disease Research Association and Rosetrees Trust, United Kingdom. Dr. Frenneaux has received personal fees from Medtronic. Dr. Cook has received personal fees from Illumina; and is a shareholder with Enleofen Bio. Dr. Cleland is on advisory boards for Medtronic and Sorin. Dr. Pennell has received a grant from Siemens; is the Director of and shareholder with CVIS; and has received personal fees from Bayer. Dr. Prasad has received funding from the British Heart Foundation, the Medical Research Council, the Coronary Artery Disease Research Association, Rosetrees, and the Alexander Jansons Foundation, United Kingdom; and has received personal fees from Bayer-Schering. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.