Late Gadolinium Enhancement by Cardiovascular Magnetic Resonance Heralds an Adverse Prognosis in Nonischemic Cardiomyopathy

Katherine C. Wu, Robert G. Weiss, David R. Thiemann, Kakuya Kitagawa, André Schmidt, Darshan Dalal, Shenghan Lai, David A. Bluemke, Gary Gerstenblith, Eduardo Marbán, Gordon F. Tomaselli, João A C Lima

Research output: Contribution to journalArticle

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Abstract

Objectives: We examined whether the presence and extent of late gadolinium enhancement (LGE) by cardiovascular magnetic resonance (CMR) predict adverse outcomes in nonischemic cardiomyopathy (NICM) patients. Background: Morbidity and mortality is high in NICM patients. However, the clinical course of an individual patient is unpredictable and current risk stratification approaches are limited. Cardiovascular magnetic resonance detects myocardial fibrosis, which appears as LGE after contrast administration and may convey prognostic importance. Methods: In a prospective cohort study, 65 NICM patients with left ventricular (LV) ejection fraction ≤35% underwent CMR before placement of an implantable cardioverter-defibrillator (ICD) for primary prevention of sudden cardiac death. The CMR images were analyzed for the presence and extent of LGE and for LV function, volumes, and mass. Patients were followed for an index composite end point of 3 cardiac events: hospitalization for heart failure, appropriate ICD firing, and cardiac death. Results: A total of 42% (n = 27) of patients had CMR LGE, averaging 10 ± 13% of LV mass. During a 17-month median follow-up, 44% (n = 12) of patients with LGE had an index composite outcome event versus only 8% (n = 3) of those without LGE (p < 0.001 for Kaplan-Meier survival curves). After adjustment for LV volume index and functional class, patients with LGE had an 8-fold higher risk of experiencing the primary outcome (hazard ratio 8.2, 95% confidence interval 2.2 to 30.9; p = 0.002). Conclusions: A CMR LGE in NICM patients strongly predicts adverse cardiac outcomes. The CMR LGE may represent the end-organ consequences of sustained adrenergic activation and adverse LV remodeling, and its identification may significantly improve risk stratification strategies in this high risk population. (Imaging Techniques for Identifying Factors of Sudden Cardiac Death Risk; NCT00181233).

Original languageEnglish (US)
Pages (from-to)2414-2421
Number of pages8
JournalJournal of the American College of Cardiology
Volume51
Issue number25
DOIs
StatePublished - Jun 24 2008
Externally publishedYes

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Gadolinium
Cardiomyopathies
Magnetic Resonance Spectroscopy
Implantable Defibrillators
Sudden Cardiac Death
Ventricular Remodeling
Kaplan-Meier Estimate
Primary Prevention
Left Ventricular Function
Stroke Volume
Adrenergic Agents
Hospitalization
Fibrosis
Cohort Studies
Heart Failure
Prospective Studies
Confidence Intervals
Morbidity
Mortality

ASJC Scopus subject areas

  • Nursing(all)

Cite this

Late Gadolinium Enhancement by Cardiovascular Magnetic Resonance Heralds an Adverse Prognosis in Nonischemic Cardiomyopathy. / Wu, Katherine C.; Weiss, Robert G.; Thiemann, David R.; Kitagawa, Kakuya; Schmidt, André; Dalal, Darshan; Lai, Shenghan; Bluemke, David A.; Gerstenblith, Gary; Marbán, Eduardo; Tomaselli, Gordon F.; Lima, João A C.

In: Journal of the American College of Cardiology, Vol. 51, No. 25, 24.06.2008, p. 2414-2421.

Research output: Contribution to journalArticle

Wu, KC, Weiss, RG, Thiemann, DR, Kitagawa, K, Schmidt, A, Dalal, D, Lai, S, Bluemke, DA, Gerstenblith, G, Marbán, E, Tomaselli, GF & Lima, JAC 2008, 'Late Gadolinium Enhancement by Cardiovascular Magnetic Resonance Heralds an Adverse Prognosis in Nonischemic Cardiomyopathy', Journal of the American College of Cardiology, vol. 51, no. 25, pp. 2414-2421. https://doi.org/10.1016/j.jacc.2008.03.018
Wu, Katherine C. ; Weiss, Robert G. ; Thiemann, David R. ; Kitagawa, Kakuya ; Schmidt, André ; Dalal, Darshan ; Lai, Shenghan ; Bluemke, David A. ; Gerstenblith, Gary ; Marbán, Eduardo ; Tomaselli, Gordon F. ; Lima, João A C. / Late Gadolinium Enhancement by Cardiovascular Magnetic Resonance Heralds an Adverse Prognosis in Nonischemic Cardiomyopathy. In: Journal of the American College of Cardiology. 2008 ; Vol. 51, No. 25. pp. 2414-2421.
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abstract = "Objectives: We examined whether the presence and extent of late gadolinium enhancement (LGE) by cardiovascular magnetic resonance (CMR) predict adverse outcomes in nonischemic cardiomyopathy (NICM) patients. Background: Morbidity and mortality is high in NICM patients. However, the clinical course of an individual patient is unpredictable and current risk stratification approaches are limited. Cardiovascular magnetic resonance detects myocardial fibrosis, which appears as LGE after contrast administration and may convey prognostic importance. Methods: In a prospective cohort study, 65 NICM patients with left ventricular (LV) ejection fraction ≤35{\%} underwent CMR before placement of an implantable cardioverter-defibrillator (ICD) for primary prevention of sudden cardiac death. The CMR images were analyzed for the presence and extent of LGE and for LV function, volumes, and mass. Patients were followed for an index composite end point of 3 cardiac events: hospitalization for heart failure, appropriate ICD firing, and cardiac death. Results: A total of 42{\%} (n = 27) of patients had CMR LGE, averaging 10 ± 13{\%} of LV mass. During a 17-month median follow-up, 44{\%} (n = 12) of patients with LGE had an index composite outcome event versus only 8{\%} (n = 3) of those without LGE (p < 0.001 for Kaplan-Meier survival curves). After adjustment for LV volume index and functional class, patients with LGE had an 8-fold higher risk of experiencing the primary outcome (hazard ratio 8.2, 95{\%} confidence interval 2.2 to 30.9; p = 0.002). Conclusions: A CMR LGE in NICM patients strongly predicts adverse cardiac outcomes. The CMR LGE may represent the end-organ consequences of sustained adrenergic activation and adverse LV remodeling, and its identification may significantly improve risk stratification strategies in this high risk population. (Imaging Techniques for Identifying Factors of Sudden Cardiac Death Risk; NCT00181233).",
author = "Wu, {Katherine C.} and Weiss, {Robert G.} and Thiemann, {David R.} and Kakuya Kitagawa and Andr{\'e} Schmidt and Darshan Dalal and Shenghan Lai and Bluemke, {David A.} and Gary Gerstenblith and Eduardo Marb{\'a}n and Tomaselli, {Gordon F.} and Lima, {Jo{\~a}o A C}",
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T1 - Late Gadolinium Enhancement by Cardiovascular Magnetic Resonance Heralds an Adverse Prognosis in Nonischemic Cardiomyopathy

AU - Wu, Katherine C.

AU - Weiss, Robert G.

AU - Thiemann, David R.

AU - Kitagawa, Kakuya

AU - Schmidt, André

AU - Dalal, Darshan

AU - Lai, Shenghan

AU - Bluemke, David A.

AU - Gerstenblith, Gary

AU - Marbán, Eduardo

AU - Tomaselli, Gordon F.

AU - Lima, João A C

PY - 2008/6/24

Y1 - 2008/6/24

N2 - Objectives: We examined whether the presence and extent of late gadolinium enhancement (LGE) by cardiovascular magnetic resonance (CMR) predict adverse outcomes in nonischemic cardiomyopathy (NICM) patients. Background: Morbidity and mortality is high in NICM patients. However, the clinical course of an individual patient is unpredictable and current risk stratification approaches are limited. Cardiovascular magnetic resonance detects myocardial fibrosis, which appears as LGE after contrast administration and may convey prognostic importance. Methods: In a prospective cohort study, 65 NICM patients with left ventricular (LV) ejection fraction ≤35% underwent CMR before placement of an implantable cardioverter-defibrillator (ICD) for primary prevention of sudden cardiac death. The CMR images were analyzed for the presence and extent of LGE and for LV function, volumes, and mass. Patients were followed for an index composite end point of 3 cardiac events: hospitalization for heart failure, appropriate ICD firing, and cardiac death. Results: A total of 42% (n = 27) of patients had CMR LGE, averaging 10 ± 13% of LV mass. During a 17-month median follow-up, 44% (n = 12) of patients with LGE had an index composite outcome event versus only 8% (n = 3) of those without LGE (p < 0.001 for Kaplan-Meier survival curves). After adjustment for LV volume index and functional class, patients with LGE had an 8-fold higher risk of experiencing the primary outcome (hazard ratio 8.2, 95% confidence interval 2.2 to 30.9; p = 0.002). Conclusions: A CMR LGE in NICM patients strongly predicts adverse cardiac outcomes. The CMR LGE may represent the end-organ consequences of sustained adrenergic activation and adverse LV remodeling, and its identification may significantly improve risk stratification strategies in this high risk population. (Imaging Techniques for Identifying Factors of Sudden Cardiac Death Risk; NCT00181233).

AB - Objectives: We examined whether the presence and extent of late gadolinium enhancement (LGE) by cardiovascular magnetic resonance (CMR) predict adverse outcomes in nonischemic cardiomyopathy (NICM) patients. Background: Morbidity and mortality is high in NICM patients. However, the clinical course of an individual patient is unpredictable and current risk stratification approaches are limited. Cardiovascular magnetic resonance detects myocardial fibrosis, which appears as LGE after contrast administration and may convey prognostic importance. Methods: In a prospective cohort study, 65 NICM patients with left ventricular (LV) ejection fraction ≤35% underwent CMR before placement of an implantable cardioverter-defibrillator (ICD) for primary prevention of sudden cardiac death. The CMR images were analyzed for the presence and extent of LGE and for LV function, volumes, and mass. Patients were followed for an index composite end point of 3 cardiac events: hospitalization for heart failure, appropriate ICD firing, and cardiac death. Results: A total of 42% (n = 27) of patients had CMR LGE, averaging 10 ± 13% of LV mass. During a 17-month median follow-up, 44% (n = 12) of patients with LGE had an index composite outcome event versus only 8% (n = 3) of those without LGE (p < 0.001 for Kaplan-Meier survival curves). After adjustment for LV volume index and functional class, patients with LGE had an 8-fold higher risk of experiencing the primary outcome (hazard ratio 8.2, 95% confidence interval 2.2 to 30.9; p = 0.002). Conclusions: A CMR LGE in NICM patients strongly predicts adverse cardiac outcomes. The CMR LGE may represent the end-organ consequences of sustained adrenergic activation and adverse LV remodeling, and its identification may significantly improve risk stratification strategies in this high risk population. (Imaging Techniques for Identifying Factors of Sudden Cardiac Death Risk; NCT00181233).

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