Abstract 14722: Prognostic Implications of Late Gadolinium Enhancement Demonstrated by Cardiac Magnetic Resonance Imaging in Patients Normal Left Ventricular Function
Background: Late gadolinium enhancement (LGE) on cardiac magnetic resonance (CMR) represents myocardial scarring. Data suggests that the presence of LGE in pts with a low left ventricular ejection fraction (LVEF) of any etiology portends adverse outcomes. We sought to assess the clinical significance of LGE in pts with a normal LVEF.
Methods: Retrospective review of 325 consecutive pts referred for CMR. Those with hypertrophic, infiltrative and congenital cardiomyopathies were excluded. The cohort was analyzed for the presence of LGE and left and right ventricle parameters. The groups were divided by presence (LGE+) or absence (LGE-) of LGE and EF ≥ 50% (LVEF+) or <50% (LVEF-). The cohort was followed for the primary endpoint of death, ICD therapy or cardiac hospitalizations, and the secondary endpoint of ICD implantation alone.
Results: 260 pts (49.5 yrs ± 19.9, 52% M, LVEF was 56% ± 13) comprised the study cohort. The most common indications for CMR were "new cardiomyopathy" or "ventricular arrhythmia". LGE was observed in 91 pts (35%) of the cohort and 200 (77%) had an LVEF ≥ 50%. Those with LGE+ were older, less likely to be male, and had a lower LVEF (51% ± 15 vs 58% ± 10; p < 0.005). Only 33 (13%) pts had both LGE and a LVEF < 50%. After a median follow up of 588 days, 20 pts experienced the primary outcome (1 death, 1 ICD shock, 18 hospitalizations); 11 events occurred in LGE+ group, and 9 events in the LGE- group (p > 0.05). There was a statistically significant difference between the four LGE/LVEF strata with respect to event-free survival (Log rank p-value=0.02). The LGE+/LVEF- subgroup had poor event-free survival (HR=5.3, 95% CI: (1.6-17.2)) compared to the LGE-/LVEF+ group. Also, for the secondary endpoint, individuals with LGE+ were more likely to get an ICD implanted, independent of LVEF (20 vs 6, p < 0.005).
Conclusions: The presence of LGE does not add additional prognostic value in those with a normal LVEF however, it does risk stratify further those with an impaired LVEF as high as 50%.
- © 2013 by American Heart Association, Inc.