PMID- 30219397 OWN - NLM STAT- MEDLINE DCOM- 20200324 LR - 20210109 IS - 1876-7591 (Electronic) IS - 1936-878X (Print) IS - 1876-7591 (Linking) VI - 12 IP - 8 Pt 2 DP - 2019 Aug TI - Outcome in Dilated Cardiomyopathy Related to the Extent, Location, and Pattern of Late Gadolinium Enhancement. PG - 1645-1655 LID - S1936-878X(18)30670-3 [pii] LID - 10.1016/j.jcmg.2018.07.015 [doi] AB - 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. CI - Copyright (c) 2019 The Authors. Published by Elsevier Inc. All rights reserved. FAU - Halliday, Brian P AU - Halliday BP AD - Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London; National Heart & Lung Institute, Imperial College, London. FAU - Baksi, A John AU - Baksi AJ AD - Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London; National Heart & Lung Institute, Imperial College, London. FAU - Gulati, Ankur AU - Gulati A AD - Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London. FAU - Ali, Aamir AU - Ali A AD - Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London; National Heart & Lung Institute, Imperial College, London. FAU - Newsome, Simon AU - Newsome S AD - London School of Hygiene and Tropical Medicine, London. FAU - Izgi, Cemil AU - Izgi C AD - Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London. FAU - Arzanauskaite, Monika AU - Arzanauskaite M AD - Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London. FAU - Lota, Amrit AU - Lota A AD - Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London; National Heart & Lung Institute, Imperial College, London. FAU - Tayal, Upasana AU - Tayal U AD - Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London; National Heart & Lung Institute, Imperial College, London. FAU - Vassiliou, Vassilios S AU - Vassiliou VS AD - Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London; National Heart & Lung Institute, Imperial College, London; Norwich Medical School, University of East Anglia, Norwich. FAU - Gregson, John AU - Gregson J AD - London School of Hygiene and Tropical Medicine, London. FAU - Alpendurada, Francisco AU - Alpendurada F AD - Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London; National Heart & Lung Institute, Imperial College, London. FAU - Frenneaux, Michael P AU - Frenneaux MP AD - Norwich Medical School, University of East Anglia, Norwich. FAU - Cook, Stuart A AU - Cook SA AD - Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London; National Heart & Lung Institute, Imperial College, London; National Heart Centre Singapore, Singapore. FAU - Cleland, John G F AU - Cleland JGF AD - National Heart & Lung Institute, Imperial College, London; Robertson Centre for Biostatistics, University of Glasgow, Glasgow. FAU - Pennell, Dudley J AU - Pennell DJ AD - Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London; National Heart & Lung Institute, Imperial College, London. Electronic address: dj.pennell@rbht.nhs.uk. FAU - Prasad, Sanjay K AU - Prasad SK AD - Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London; National Heart & Lung Institute, Imperial College, London. LA - eng GR - FS/15/29/31492/BHF_/British Heart Foundation/United Kingdom GR - FS/17/21/32712/BHF_/British Heart Foundation/United Kingdom GR - MR/M003191/1/MRC_/Medical Research Council/United Kingdom PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20180912 PL - United States TA - JACC Cardiovasc Imaging JT - JACC. Cardiovascular imaging JID - 101467978 RN - 0 (Contrast Media) RN - 0 (Organometallic Compounds) RN - 1BJ477IO2L (gadobutrol) RN - K2I13DR72L (Gadolinium DTPA) SB - IM CIN - JACC Cardiovasc Imaging. 2019 Aug;12(8 Pt 2):1656-1658. PMID: 30219396 MH - Adult MH - Aged MH - Cardiomyopathy, Dilated/complications/*diagnostic imaging/mortality/physiopathology MH - Cause of Death MH - Contrast Media/*administration & dosage MH - Death, Sudden, Cardiac/*etiology MH - Female MH - Fibrosis MH - Gadolinium DTPA/*administration & dosage MH - Humans MH - *Magnetic Resonance Imaging MH - Male MH - Middle Aged MH - Myocardium/pathology MH - Organometallic Compounds/*administration & dosage MH - Predictive Value of Tests MH - Prognosis MH - Registries MH - Risk Assessment MH - Risk Factors MH - Stroke Volume MH - Time Factors MH - Ventricular Function, Left MH - Ventricular Function, Right PMC - PMC6682609 MID - EMS81833 OTO - NOTNLM OT - cardiovascular magnetic resonance OT - dilated cardiomyopathy OT - late gadolinium enhancement EDAT- 2018/09/17 06:00 MHDA- 2020/03/25 06:00 PMCR- 2019/08/01 CRDT- 2018/09/17 06:00 PHST- 2018/02/12 00:00 [received] PHST- 2018/07/11 00:00 [revised] PHST- 2018/07/12 00:00 [accepted] PHST- 2018/09/17 06:00 [pubmed] PHST- 2020/03/25 06:00 [medline] PHST- 2018/09/17 06:00 [entrez] PHST- 2019/08/01 00:00 [pmc-release] AID - S1936-878X(18)30670-3 [pii] AID - 10.1016/j.jcmg.2018.07.015 [doi] PST - ppublish SO - JACC Cardiovasc Imaging. 2019 Aug;12(8 Pt 2):1645-1655. doi: 10.1016/j.jcmg.2018.07.015. Epub 2018 Sep 12.