Abstract 17697: Utility of Late Gadolinium Enhancement on Cardiac MRI in Predicting Clinically Significant Ventricular Arrhythmias in Patients With Dilated Cardiomyopathy: A Meta-analysis of Observational Studies
Introduction: Late gadolinium enhancement (LGE) on cardiac magnetic resonance imaging (cMRI) has been shown to predict mortality and morbidity in patients with idiopathic dilated cardiomyopathy (DCM). However, the predictive value of LGE on major ventricular arrhythmias particularly sudden death in DCM is unproven.
Methods: A comprehensive search of articles assessing the predictive role of cMRI on clinically relevant ventricular arrhythmias [Sudden cardiac death (SCD), aborted SCD, sustained ventricular tachycardia (VT), ventricular fibrillation (VF), Appropriate Implantable Cardioverter Defibrillator (ICD) shock] was done in PUBMED and COCHRANE databases through May, 2013 combining the search terms “late gadolinium enhancement”, “Cardiac MRI”, “Delayed gadolinium enhancement”, “Dilated cardiomyopathy”, “ ventricular arrhythmia”, “sudden cardiac death” and “ICD therapy”. After screening abstracts, full texts of potentially relevant studies were reviewed by two authors. Data was extracted on standardized forms. Meta-analysis was performed following the MOOSE criteria and PRISMA statement using a random effects model. The main measure of association was relative risk and 95% of confidence interval (CI), with 0.5 added to the arms with zero events.
Results: A total of 1189 patients across 7 studies were included in the analysis based on predefined inclusion and exclusion criteria. There was significant excess risk of clinically relevant ventricular arrhythmias (CRVA) in DCM patients with LGE on cMRI compared to those without LGE [relative risk: 3.88 (2.75-5.46; p< 0.0001)]. There was no significant heterogeneity (Cochran Q: 3.4; P=0.7; I2=0) or publication bias by funnel plot and Egger regression test. Sensitivity analyses using Fixed-effects model and exclusion of individual studies had no impact on the summary effect estimate.
Conclusion: Presence of LGE in patients with DCM confers a higher risk of CRVA consisting of SCD, aborted SCD, sustained VT/ VF and appropriate ICD shocks. cMRI may be helpful for refining current risk stratification in patients with DCM and improve our ability to identify candidates for ICD (primary prevention) more efficiently.
- Cardiac MRI
- Ventricular tachycardia
- Ventricular fibrillation
- Sudden cardiac death
- Implantable cardioconvert defibrillator
- © 2013 by American Heart Association, Inc.