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Late Gadolinium Enhancement in Dilated Cardiomyopathy and SCD risk

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Di Marco et al report a systematic review and meta-analysis of the relationship between late gadolinium enhancement on cardiac MRI in patients with dilated cardiomyopathy and ventricular arrhythmias. The authors suggest that the evidence for independent prognostic value has implications for primary prevention ICD’s.

Abstract

OBJECTIVES

The aim of this study was to evaluate the association between late gadolinium enhancement (LGE) on cardiac magnetic resonance imaging and ventricular arrhythmias or sudden cardiac death (SCD) in patients with dilated
cardiomyopathy (DCM).

BACKGROUND

Risk stratification for SCD in DCM needs to be improved.

METHODS

A systematic review and meta-analysis were conducted. A systematic search of PubMed and Ovid was performed, and observational studies that analyzed the arrhythmic endpoint (sustained ventricular arrhythmia, appropriate implantable cardioverter-defibrillator [ICD] therapy, or SCD) in patients with DCM, stratified by the presence or absence of LGE, were included.

RESULTS

Twenty-nine studies were included, accounting for 2,948 patients. The studies covered a wide spectrum of DCM, with a mean left ventricular ejection fraction between 20% and 43%. LGE was significantly associated with the arrhythmic endpoint both in the overall population (odds ratio: 4.3; p < 0.001) and when including only those studies that performed multivariate analysis (hazard ratio: 6.7; p < 0.001). The association between LGE and the arrhythmic endpoint remained significant among studies with mean left ventricular ejection fractions >35% (odds ratio: 5.2; p < 0.001) and was maximal in studies that included only patients with primary prevention ICDs (odds ratio: 7.8;
p ¼ 0.008).

CONCLUSIONS

Across a wide spectrum of patients with DCM, LGE is strongly and independently associated with ventricular arrhythmia or SCD. LGE could be a powerful tool to improve risk stratification for SCD in patients with DCM. These results raise 2 major questions to be addressed in future studies: whether patients with LGE could benefit from primary prevention ICDs irrespective of their left ventricular ejection fractions, while patients without LGE might not need
preventive ICDs despite having severe left ventricular dysfunction.

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