Outcome in dilated cardiomyopathy related to the extent, location and pattern of late gadolinium enhancement

Halliday, B. P. et al. (2019) Outcome in dilated cardiomyopathy related to the extent, location and pattern of late gadolinium enhancement. JACC: Cardiovascular Imaging, 12(8 Pt 2), pp. 1645-1655. (doi: 10.1016/j.jcmg.2018.07.015) (PMID:30219397) (PMCID:PMC6682609)

Abstract

Objectives: This study sought to investigate the association between the extent, location, and pattern of late gadolinium enhancement (LGE) and outcome in a large dilated cardiomyopathy (DCM) cohort. Background: The relationship between LGE and prognosis in DCM is incompletely understood. Methods: We examined the association between LGE and all-cause mortality and a sudden cardiac death (SCD) composite based on the extent, location, and pattern of LGE in DCM. Results: Of 874 patients (588 men, median age 52 years) followed for a median of 4.9 years, 300 (34.3%) had nonischemic LGE. Estimated adjusted hazard ratios for patients with an LGE extent of 0 to 2.55%, 2.55% to 5.10%, and >5.10%, respectively, were 1.59 (95% confidence interval [CI]: 0.99 to 2.55), 1.56 (95% CI: 0.96 to 2.54), and 2.31 (95% CI: 1.50 to 3.55) for all-cause mortality, and 2.79 (95% CI: 1.42 to 5.49), 3.86 (95% CI: 2.09 to 7.13), and 4.87 (95% CI: 2.78 to 8.53) for the SCD end-point. There was a marked nonlinear relationship between LGE extent and outcome such that even small amounts of LGE predicted a substantial increase in risk. The presence of septal LGE was associated with increased mortality, but SCD was most associated with the combined presence of septal and free-wall LGE. Predictive models using LGE presence and location were superior to models based on LGE extent or pattern. Conclusions: In DCM, the presence of septal LGE is associated with a large increase in the risk of death and SCD events, even when the extent is small. SCD risk is greatest with concomitant septal and free-wall LGE. The incremental value of LGE extent beyond small amounts and LGE pattern is limited.

• Item Type: Articles
• Additional Information: The work was supported by the Cardiovascular Research Centre at Royal Brompton and Harefield NHS Foundation Trust, UK and Imperial College, London, UK. BPH is supported by a British Heart Foundation Clinical Research Training Fellowship, UK (FS/15/29/31492). AG received funding from the Coronary Artery Disease Research Association and Rosetrees Trust, UK. SKP has received funding from British Heart Foundation, the Medical Research Council, the Coronary Artery Disease Research Association, Rosetrees and the Alexander Jansons Foundation, UK.
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Cleland, Professor John
• Authors: Halliday, B. P., Baksi, A. J., Gulati, A., Ali, A., Newsome, S., Izgi, C., Arzanauskaite, M., Lota, A., Tayal, U., Vassiliou, V. S., Gregson, J., Alpendurada, F., Frenneaux, M. P., Cook, S. A., Cleland, J. G.F., Pennell, D. J., and Prasad, S. K.
• College/School: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Robertson Centre
• Journal Name: JACC: Cardiovascular Imaging
• Publisher: Elsevier
• ISSN: 1936-878X
• ISSN (Online): 1876-7591
• Published Online: 12 September 2018
• Copyright Holders: Copyright © 2018 The Authors
• First Published: First published in JACC: Cardiovascular Imaging 12(8 Pt 2): 1645-1655
• Publisher Policy: Reproduced under a Creative Commons License