PMID- 23932642 OWN - NLM STAT- MEDLINE DCOM- 20140429 LR - 20240213 IS - 1876-7591 (Electronic) IS - 1936-878X (Print) IS - 1876-7591 (Linking) VI - 6 IP - 9 DP - 2013 Sep TI - CMR quantification of myocardial scar provides additive prognostic information in nonischemic cardiomyopathy. PG - 944-54 LID - S1936-878X(13)00475-0 [pii] LID - 10.1016/j.jcmg.2013.05.013 [doi] AB - 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. CI - Copyright (c) 2013 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved. FAU - Neilan, Tomas G AU - Neilan TG AD - 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. FAU - Coelho-Filho, Otavio R AU - Coelho-Filho OR FAU - Danik, Stephan B AU - Danik SB FAU - Shah, Ravi V AU - Shah RV FAU - Dodson, John A AU - Dodson JA FAU - Verdini, Daniel J AU - Verdini DJ FAU - Tokuda, Michifumi AU - Tokuda M FAU - Daly, Caroline A AU - Daly CA FAU - Tedrow, Usha B AU - Tedrow UB FAU - Stevenson, William G AU - Stevenson WG FAU - Jerosch-Herold, Michael AU - Jerosch-Herold M FAU - Ghoshhajra, Brian B AU - Ghoshhajra BB FAU - Kwong, Raymond Y AU - Kwong RY LA - eng GR - T32 HL094301/HL/NHLBI NIH HHS/United States GR - R01HL090634-01A1/HL/NHLBI NIH HHS/United States GR - R01 HL090634/HL/NHLBI NIH HHS/United States GR - R01HL091157/HL/NHLBI NIH HHS/United States GR - R01 HL091157/HL/NHLBI NIH HHS/United States GR - T32 HL094301-02/HL/NHLBI NIH HHS/United States PT - Comparative Study PT - Journal Article PT - Multicenter Study PT - Research Support, N.I.H., Extramural PT - Research Support, Non-U.S. Gov't DEP - 20130808 PL - United States TA - JACC Cardiovasc Imaging JT - JACC. Cardiovascular imaging JID - 101467978 SB - IM MH - Cardiomyopathy, Dilated/complications/*diagnosis/physiopathology MH - Cicatrix/complications/*diagnosis MH - Diagnosis, Differential MH - Female MH - Follow-Up Studies MH - Humans MH - Magnetic Resonance Imaging, Cine/*methods MH - Male MH - Middle Aged MH - Myocardium/*pathology MH - Prognosis MH - Prospective Studies MH - *Ventricular Function, Left PMC - PMC3952043 MID - NIHMS559555 OTO - NOTNLM OT - CMR OT - EF OT - FWHM OT - ICD OT - LGE OT - MACE OT - NIDC OT - SCD OT - VT OT - cardiac magnetic resonance OT - ejection fraction OT - full-width half-maximum OT - implantable cardioverter-defibrillator OT - implantable cardioverter-defibrillators OT - late gadolinium enhancement OT - late gadolinium enhancement OT - major adverse cardiac events OT - nonischemic cardiomyopathy OT - nonischemic dilated cardiomyopathy OT - sudden cardiac death OT - ventricular tachycardia COIS- All authors have reported that they have no relationships relevant to the contents of this paper to disclose. EDAT- 2013/08/13 06:00 MHDA- 2014/04/30 06:00 PMCR- 2014/03/13 CRDT- 2013/08/13 06:00 PHST- 2012/03/05 00:00 [received] PHST- 2013/04/18 00:00 [revised] PHST- 2013/05/05 00:00 [accepted] PHST- 2013/08/13 06:00 [entrez] PHST- 2013/08/13 06:00 [pubmed] PHST- 2014/04/30 06:00 [medline] PHST- 2014/03/13 00:00 [pmc-release] AID - S1936-878X(13)00475-0 [pii] AID - 10.1016/j.jcmg.2013.05.013 [doi] PST - ppublish SO - JACC Cardiovasc Imaging. 2013 Sep;6(9):944-54. doi: 10.1016/j.jcmg.2013.05.013. Epub 2013 Aug 8.