PMID- 18565399 OWN - NLM STAT- MEDLINE DCOM- 20080722 LR - 20211020 IS - 1558-3597 (Electronic) IS - 0735-1097 (Print) IS - 0735-1097 (Linking) VI - 51 IP - 25 DP - 2008 Jun 24 TI - Late gadolinium enhancement by cardiovascular magnetic resonance heralds an adverse prognosis in nonischemic cardiomyopathy. PG - 2414-21 LID - 10.1016/j.jacc.2008.03.018 [doi] AB - OBJECTIVES: We examined whether the presence and extent of late gadolinium enhancement (LGE) by cardiovascular magnetic resonance (CMR) predict adverse outcomes in nonischemic cardiomyopathy (NICM) patients. BACKGROUND: Morbidity and mortality is high in NICM patients. However, the clinical course of an individual patient is unpredictable and current risk stratification approaches are limited. Cardiovascular magnetic resonance detects myocardial fibrosis, which appears as LGE after contrast administration and may convey prognostic importance. METHODS: In a prospective cohort study, 65 NICM patients with left ventricular (LV) ejection fraction < or =35% underwent CMR before placement of an implantable cardioverter-defibrillator (ICD) for primary prevention of sudden cardiac death. The CMR images were analyzed for the presence and extent of LGE and for LV function, volumes, and mass. Patients were followed for an index composite end point of 3 cardiac events: hospitalization for heart failure, appropriate ICD firing, and cardiac death. RESULTS: A total of 42% (n = 27) of patients had CMR LGE, averaging 10 +/- 13% of LV mass. During a 17-month median follow-up, 44% (n = 12) of patients with LGE had an index composite outcome event versus only 8% (n = 3) of those without LGE (p < 0.001 for Kaplan-Meier survival curves). After adjustment for LV volume index and functional class, patients with LGE had an 8-fold higher risk of experiencing the primary outcome (hazard ratio 8.2, 95% confidence interval 2.2 to 30.9; p = 0.002). CONCLUSIONS: A CMR LGE in NICM patients strongly predicts adverse cardiac outcomes. The CMR LGE may represent the end-organ consequences of sustained adrenergic activation and adverse LV remodeling, and its identification may significantly improve risk stratification strategies in this high risk population. (Imaging Techniques for Identifying Factors of Sudden Cardiac Death Risk; NCT00181233). FAU - Wu, Katherine C AU - Wu KC AD - Division of Cardiology, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, Maryland 21287, USA. kwu@jhmi.edu FAU - Weiss, Robert G AU - Weiss RG FAU - Thiemann, David R AU - Thiemann DR FAU - Kitagawa, Kakuya AU - Kitagawa K FAU - Schmidt, Andre AU - Schmidt A FAU - Dalal, Darshan AU - Dalal D FAU - Lai, Shenghan AU - Lai S FAU - Bluemke, David A AU - Bluemke DA FAU - Gerstenblith, Gary AU - Gerstenblith G FAU - Marban, Eduardo AU - Marban E FAU - Tomaselli, Gordon F AU - Tomaselli GF FAU - Lima, Joao A C AU - Lima JA LA - eng SI - ClinicalTrials.gov/NCT00181233 GR - K23 HL004444-01/HL/NHLBI NIH HHS/United States GR - K23 HL004444-05/HL/NHLBI NIH HHS/United States GR - K23 HL004444-04/HL/NHLBI NIH HHS/United States GR - K23 HL004444-03/HL/NHLBI NIH HHS/United States GR - K23 HL04444/HL/NHLBI NIH HHS/United States GR - K23 HL004444/HL/NHLBI NIH HHS/United States GR - K23 HL004444-02/HL/NHLBI NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural PT - Research Support, Non-U.S. Gov't PL - United States TA - J Am Coll Cardiol JT - Journal of the American College of Cardiology JID - 8301365 RN - 0 (Contrast Media) RN - AU0V1LM3JT (Gadolinium) SB - IM MH - Cardiomyopathies/*diagnosis/mortality/physiopathology MH - *Contrast Media MH - Defibrillators, Implantable MH - Disease Progression MH - Female MH - *Gadolinium MH - Hospitalization MH - Humans MH - Hypertrophy, Left Ventricular/*diagnosis/physiopathology MH - Image Enhancement/instrumentation/methods MH - Imaging, Three-Dimensional/instrumentation/methods MH - Kaplan-Meier Estimate MH - Magnetic Resonance Imaging/*instrumentation/methods MH - Male MH - Middle Aged MH - Predictive Value of Tests MH - Prognosis MH - Prospective Studies MH - Research Design MH - Risk Assessment MH - Stroke Volume MH - Time Factors MH - Treatment Outcome PMC - PMC2459322 MID - NIHMS55246 EDAT- 2008/06/21 09:00 MHDA- 2008/07/23 09:00 PMCR- 2009/06/24 CRDT- 2008/06/21 09:00 PHST- 2007/11/27 00:00 [received] PHST- 2008/03/13 00:00 [revised] PHST- 2008/03/17 00:00 [accepted] PHST- 2008/06/21 09:00 [pubmed] PHST- 2008/07/23 09:00 [medline] PHST- 2008/06/21 09:00 [entrez] PHST- 2009/06/24 00:00 [pmc-release] AID - S0735-1097(08)01113-3 [pii] AID - 10.1016/j.jacc.2008.03.018 [doi] PST - ppublish SO - J Am Coll Cardiol. 2008 Jun 24;51(25):2414-21. doi: 10.1016/j.jacc.2008.03.018.