Author + information
- Received November 27, 2007
- Revision received March 13, 2008
- Accepted March 17, 2008
- Published online June 24, 2008.
- Katherine C. Wu, MD, FACC⁎,⁎ (, )
- Robert G. Weiss, MD⁎,‡,
- David R. Thiemann, MD⁎,§,
- Kakuya Kitagawa, MD⁎,
- André Schmidt, MD⁎,
- Darshan Dalal, MD⁎,
- Shenghan Lai, MD, PhD†,
- David A. Bluemke, MD, PhD⁎,‡,
- Gary Gerstenblith, MD, FACC⁎,
- Eduardo Marbán, MD, PhD, FACC⁎ and
- João A.C. Lima, MD, FACC⁎,‡
- ↵⁎Reprint requests and correspondence:
Dr. Katherine C. Wu, Division of Cardiology, Johns Hopkins Hospital, 600 North Wolfe Street/Carnegie 568, Baltimore, Maryland 21287.
- Gordon F. Tomaselli, MD, FACC
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)
Supported by the Donald W. Reynolds Cardiovascular Research Center at Johns Hopkins University and the National Heart, Lung, and Blood Institute, National Institutes of Health (K23 HL04444 to Dr. Wu). Drs. Wu and Lima receive research grant support from GE Healthcare Technologies.
- Received November 27, 2007.
- Revision received March 13, 2008.
- Accepted March 17, 2008.
- American College of Cardiology Foundation