TY - JOUR
T1 - Late Gadolinium Enhancement and the Risk for Ventricular Arrhythmias or Sudden Death in Dilated Cardiomyopathy
T2 - Systematic Review and Meta-Analysis
AU - Di Marco, Andrea
AU - Anguera, Ignasi
AU - Schmitt, Matthias
AU - Klem, Igor
AU - Neilan, Thomas
AU - White, James A.
AU - Sramko, Marek
AU - Masci, Pier Giorgio
AU - Barison, Andrea
AU - Mckenna, Peter
AU - Mordi, Ify
AU - Haugaa, Kristina H.
AU - Leyva, Francisco
AU - Rodriguez Capitán, Jorge
AU - Satoh, Hiroshi
AU - Nabeta, Takeru
AU - Dallaglio, Paolo Domenico
AU - Campbell, Niall G.
AU - Sabaté, Xavier
AU - Cequier, Ángel
PY - 2017/1/1
Y1 - 2017/1/1
N2 - 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 = 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.
AB - 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 = 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.
KW - cardiac magnetic resonance
KW - dilated cardiomyopathy
KW - late gadolinium enhancement
KW - sudden death
KW - ventricular arrhythmias
UR - http://www.scopus.com/inward/record.url?scp=85007552187&partnerID=8YFLogxK
U2 - 10.1016/j.jchf.2016.09.017
DO - 10.1016/j.jchf.2016.09.017
M3 - Article
AN - SCOPUS:85007552187
SN - 2213-1779
VL - 5
SP - 28
EP - 38
JO - JACC: Heart Failure
JF - JACC: Heart Failure
IS - 1
ER -
