The extent and location of late gadolinium enhancement predict defibrillator shock and cardiac mortality in patients with non-ischaemic dilated cardiomyopathy

• Published in: International journal of cardiology Vol. 307; pp. 180 - 186
• Main Authors: Barison, Andrea, Aimo, Alberto, Mirizzi, Gianluca, Castiglione, Vincenzo, Ripoli, Andrea, Panchetti, Luca, Rossi, Andrea, Giannoni, Alberto, Startari, Umberto, Aquaro, Giovanni Donato, Emdin, Michele, Piacenti, Marcello
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 15.05.2020
• Subjects: Defibrillator; Late gadolinium enhancement; Prognosis; Shock; Ventricular arrhythmias; RR; Shock; Ventricular arrhythmias; Prognosis; CRT; Late gadolinium enhancement; LVEF; HR; LV; SCD-HeFT; RVIP; DANISH; NT-proBNP; b.p.m; NYHA; EHRs; AF; CI; CMR; ICD; LGE; VF; SCD; ATP; HF; NIDCM; VT; Defibrillator
• ISSN: 0167-5273; 1874-1754
• DOI: 10.1016/j.ijcard.2020.02.028

In non-ischaemic dilated cardiomyopathy (NIDCM), it is uncertain which late gadolinium enhancement (LGE) pattern, extent and location predict ventricular arrhythmias. We analysed 183 NIDCM patients (73% men, median age 66 years) receiving an implantable cardioverter defibrillator (ICD) for primary prevention, undergoing cardiac magnetic resonance within 1 month before implantation. The primary endpoint was appropriate ICD shock, the secondary endpoint was a composite of appropriate ICD shock and cardiac death. LGE was found in 116 patients (63%), accounting for 9% of LV mass (5–13%). Over a 30-month follow-up (10–65), 20 patients (11%) experienced the primary and 30 patients (16%) the secondary endpoint. LGE presence, inferior wall LGE, diffuse (≥2 wall) LGE, the number of segments with LGE, the number of segments with 50–75% transmural LGE, and percent LGE mass were univariate predictors of both endpoints. Also septal LGE predicted the primary, and lateral LGE predicted the secondary endpoint. LGE limited to right ventricular insertion points did not predict any endpoint. Percent LGE mass had an area under the curve of 0.734 for the primary endpoint, with 13% as the best cut-off (55% sensitivity, 86% specificity, 32% PPV, 94% NPV), conferring a 7-fold higher risk compared to patients with no LGE or LGE <13%. Survival free from both endpoints was significantly worse for patients with LGE ≥13%. In patients with NIDCM receiving a defibrillator for primary prevention, LGE presence and extent predicted appropriate ICD shock and cardiac mortality; also specific LGE patterns and locations predicted a worse prognosis. •LGE presence, extent, location and transmurality predicted ICD shock/cardiac death.•The best cut-off for percent LGE mass was 13% for appropriate ICD shock.•Percentage LGE mass showed a “plateau” relationship with ICD shock.•Percentage LGE mass showed a linear relationship with ICD shock/cardiac death.•Insertion point LGE and LGE pattern (subepicardial/midwall) did not predict outcome.