Author + information
- Received May 15, 2012
- Revision received August 17, 2012
- Accepted September 5, 2012
- Published online March 1, 2013.
- Dana K. Dawson, DM, DPhil⁎,⁎ (, )
- Karin Hawlisch, MD†,
- Gordon Prescott, PhD⁎,
- Isabelle Roussin, MD†,
- Elisa Di Pietro, MD†,
- Monica Deac, MD†,
- Joyce Wong, MD†,
- Michael P. Frenneaux, MD⁎,
- Dudley J. Pennell, MD† and
- Sanjay K. Prasad, MD†
- ↵⁎Reprint requests and correspondence:
Dr. Dana K. Dawson, Cardiovascular Medicine Research Unit, School of Medicine and Dentistry, University of Aberdeen, Aberdeen, AB25 2ZD, United Kingdom
Objectives The goal of this study was to explore whether fibrosis detected by late gadolinium enhancement cardiac magnetic resonance (LGE-CMR) is an independent predictor of hard cardiovascular events in patients presenting with ventricular arrhythmia.
Background In patients at risk of sudden cardiac death, risk stratification for device therapy remains challenging.
Methods A total of 373 consecutive patients with sustained ventricular tachycardia (VT) (n = 204) or nonsustained ventricular tachycardia (NSVT) (n = 169) underwent LGE-CMR. The group was prospectively followed up for a median of 2.6 years (range 11 months to 11 years). The predetermined endpoint was a composite of cardiac death/arrest, new episode of sustained VT, or appropriate implantable cardioverter-defibrillator discharge.
Results Mean left ventricular (LV) ejection fraction (EF) was 60 ± 13%. The presence of fibrosis was a strong and independent predictor of the primary outcome for the whole group (hazard ratio [HR]: 3.3, 95% confidence interval [CI]: 1.8 to 5.8, p < 0.001). In the sustained VT subset, both LV fibrosis and severely impaired systolic function (LVEF <35%) were significant independent predictors in the multivariate model (HR: 3.0, 95% CI: 1.4 to 6.2, p = 0.001; and HR: 2.5, 95% CI: 1.1 to 6.2, p = 0.038, respectively). In the NSVT subset, the presence of fibrosis was the only independent predictor of the endpoint (HR: 4.2, 95% CI: 1.7 to 10.1, p = 0.006).
Conclusions LGE-CMR–detected fibrosis is an independent predictor of adverse outcomes in patients with ventricular arrhythmia and may have an important role in risk stratification.
(The Prognostic Significance of Fibrosis Detection in Ischemic and Non-Ischemic Cardiomyopathy; NCT00930735)
- cardiac magnetic resonance
- late gadolinium enhancement
- nonsustained ventricular tachycardia
- ventricular tachycardia
This study was supported by the UK NIHR Cardiovascular Biomedical Research Unit of Royal Brompton & Harefield NHS Foundation Trust and Imperial College. Dr. Dawson was the recipient of the van Geest Advanced Imaging Fellowship. Dr. Frenneaux has been a paid speaker for the Menarini Group. Dr. Pennell is a consultant for Siemens, and a shareholder in and Director of Cardiovascular Imaging Solutions Ltd. Dr. Prasad has received honoraria for talks from Bayer Schering. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received May 15, 2012.
- Revision received August 17, 2012.
- Accepted September 5, 2012.
- American College of Cardiology Foundation