Abstract 14794: Arrhythmic Risk Stratification In Non-ischemic Dilated Cardiomyopathies: Additional Value Of Left Ventricular Myocardial Scar Visualized By Contrast-enhanced Cardiac Magnetic Resonance
Purpose: the role of myocardial fibrosis for risk stratification of adverse arrhythmic events in non-ischemic dilated cardiomyopathy (DCM) is still unclear. The aim of the present study was to asses the role of presence and amount of late gadolinium enhancement (LGE) as detected by contrast-enhanced cardiac magnetic resonance (CE-CMR) for arrhythmic stratification in patients with non-ischemic DCM.
Methods: 111 consecutive patients (90 males, 81.1%; mean age 49.9±15.7 years) with non-ischemic DCM were prospectively enrolled. All patients underwent initial CE-CMR and were followed for the primary end point of sustained ventricular tachycardia (SVT), and for the composite and point of SVT, appropriate ICD intervention and sudden cardiac death (SCD) for a mean follow-up of 35±15 months. For each patient the LGE was classified as absent, “gray” pattern, midwall/subepicadial stria and “patchy” and quantified as percentage of left ventricular (LV) mass.
Results: LGE was identified in 67 patients (60%) and affected 6.3%±8.8% of LV wall. A “gray” pattern was observe in 12 (17.9%), a stria pattern in 49 (73.1%), a septal junction pattern in 29 (26%), a “patchy” pattern in 2 (2.9%). During the follow-up period, 49 of 111 patients (44%) experienced adverse events, such as sustained VT (n=18), sudden death (SD) (n=10), appropriate ICD interventions (n=7). On univariate analysis, the CE-CMR variables significantly associated with composite and point were the presence of LGE (HR= 2.2; CI:1.23-3.91; p<0.008); a LGE “gray” pattern (HR= 4.2; CI:1.21-14.7; p=0.02), and a total LGE amount (≥2.5%) of LV mass (HR= 2.12; CI:1.17-3.8; p=0.013). Kaplan-Meier analysis revealed a significant correlation between the presence of LV-LGE and occurrence of malignant arrhythmic events during the follow-up (p<0.05). On multivariable analysis, after adjustment for age, NYHA class, LV volume and impaired ejection fraction, the presence of LV-LGE remained an independent predictor of malignant arrhythmic outcome (HR= 2.5; CI:1.36-4.73; p<0.0003).
Conclusions: In patients with DCM, LV myocardial scar as measured by LGE on CE-CMR, is an independent predictor of adverse outcome and may contribute to assess the arrhythmogenic risk and to identify candidates for ICD therapy.
- © 2011 by American Heart Association, Inc.