Author + information
- Received March 5, 2012
- Revision received April 18, 2013
- Accepted May 5, 2013
- Published online September 1, 2013.
- Tomas G. Neilan, MD∗,†,‡,
- Otavio R. Coelho-Filho, MD∗,
- Stephan B. Danik, MD†,
- Ravi V. Shah, MD∗,†,
- John A. Dodson, MD∗,
- Daniel J. Verdini, MD‡,
- Michifumi Tokuda, MD∗,
- Caroline A. Daly, MD∗,
- Usha B. Tedrow, MD∗,
- William G. Stevenson, MD∗,
- Michael Jerosch-Herold, PhD∗,
- Brian B. Ghoshhajra, MD‡ and
- Raymond Y. Kwong, MD, MPH∗∗ ()
- ∗Non-invasive Cardiovascular Imaging Section, Cardiovascular Division, Department of Medicine and Radiology, Brigham and Women's Hospital, Boston, Massachusetts
- †Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
- ‡Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
- ↵∗Reprint requests and correspondence:
Dr. Raymond Y. Kwong, Cardiac Magnetic Resonance Imaging, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, Massachusetts 02115.
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.
- cardiac magnetic resonance
- implantable cardioverter-defibrillators
- late gadolinium enhancement
- nonischemic cardiomyopathy
This work was supported by an American Heart Association Fellow to Faculty Grant (12FTF12060588, to Dr. Neilan), a National Institutes of Health T32 Training Grant (T32 HL094301-02, to Dr. Neilan), and National Institutes of Health research grants (R01HL090634-01A1, MJH; R01HL091157, to Dr. Kwong). All authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received March 5, 2012.
- Revision received April 18, 2013.
- Accepted May 5, 2013.
- American College of Cardiology Foundation