Prognostic Role of CMR in Patients Presenting With Ventricular Arrhythmias

Dana K. Dawson*, Karin Hawlisch, Gordon Prescott, Isabelle Roussin, Elisa Di Pietro, Monica Deac, Joyce Wong, Michael P. Frenneaux, Dudley J. Pennell, Sanjay K. Prasad, Gordon James Prescott

*Corresponding author for this work

Research output: Contribution to journalArticle

51 Citations (Scopus)

Abstract

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) (J Am Coll Cardiol Img 2013; 6: 335-44) (C) 2013 by the American College of Cardiology Foundation

Original languageEnglish
Pages (from-to)335-344
Number of pages10
JournalJACC. Cardiovascular Imaging
Volume6
Issue number3
Early online date20 Feb 2013
DOIs
Publication statusPublished - Mar 2013

Keywords

  • cardiac magnetic resonance
  • fibrosis
  • late gadolinium enhancement
  • nonsustained ventricular tachycardia
  • ventricular tachycardia
  • cardiovascular magnetic-resonance
  • implantable cardioverter-defibrillator
  • antiarrhythmic-drug therapy
  • hypertrophic cardiomyopathy
  • nonischemic cardiomyopathy
  • ischemic cardiomyopathy
  • dilated cardiomyopathy
  • myocardial-infarction
  • tachycardia

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    Dawson, D. K., Hawlisch, K., Prescott, G., Roussin, I., Di Pietro, E., Deac, M., Wong, J., Frenneaux, M. P., Pennell, D. J., Prasad, S. K., & Prescott, G. J. (2013). Prognostic Role of CMR in Patients Presenting With Ventricular Arrhythmias. JACC. Cardiovascular Imaging, 6(3), 335-344. https://doi.org/10.1016/j.jcmg.2012.09.012