ABSTRACT
BACKGROUND: Late gadolinium enhancement (LGE) assessed with cardiovascular magnetic resonance (CMR) correlates with ventricular arrhythmias and survival in patients with structural heart disease. Whether some LGE characteristics may specifically improve prediction of arrhythmic outcomes is unknown. HYPOTHESIS: We sought to evaluate scar characteristics assessed with CMR to predict implantable cardioverter-defibrillator (ICD) interventions in dilated cardiomyopathy of different etiology. METHODS: 96 consecutive patients evaluated with CMR received an ICD. Biventricular volumes, ejection fraction, and myocardial LGE were evaluated. LGE was defined as "complex" (Cx-LGE) in presence of ≥1 of the following: ischemic pattern, involving ≥2 different coronary territories; epicardial pattern; global endocardial pattern; and presence of ≥2 different patterns. The primary endpoint was occurrence of any appropriate ICD intervention. A composite secondary endpoint of cardiovascular death, cardiac transplantation, or ventricular assist device implantation was also considered. RESULTS: During a median follow-up of 75 months, 30 and 25 patients reached the primary and secondary endpoints, respectively. Cx-LGE was correlated with a worse primary endpoint survival (log-rank P < 0.001). Cx-LGE and right ventricular end-diastolic volume were independently associated with the primary endpoint (HR: 3.22, 95% CI: 1.56-6.65, P = 0.002; and HR: 1.06, 95% CI: 1.00-1.12, P = 0.045, respectively), but not with the secondary endpoint. CONCLUSIONS: Cx-LGE identified at CMR imaging seems promising as an independent and specific prognostic factor of ventricular arrhythmias requiring ICD therapy in dilated cardiomyopathy of different etiologies.
Subject(s)
Arrhythmias, Cardiac/diagnostic imaging , Cardiomyopathy, Dilated/diagnostic imaging , Cicatrix/diagnostic imaging , Clinical Decision-Making , Defibrillators, Implantable , Electric Countershock/instrumentation , Magnetic Resonance Imaging, Cine , Adult , Aged , Aged, 80 and over , Arrhythmias, Cardiac/etiology , Arrhythmias, Cardiac/physiopathology , Arrhythmias, Cardiac/therapy , Cardiomyopathy, Dilated/etiology , Cardiomyopathy, Dilated/physiopathology , Cardiomyopathy, Dilated/therapy , Cicatrix/etiology , Cicatrix/physiopathology , Cicatrix/therapy , Contrast Media/administration & dosage , Death, Sudden, Cardiac/etiology , Death, Sudden, Cardiac/prevention & control , Disease Progression , Disease-Free Survival , Female , Gadolinium DTPA/administration & dosage , Humans , Male , Middle Aged , Patient Selection , Predictive Value of Tests , Recovery of Function , Registries , Retrospective Studies , Risk Factors , Time Factors , Treatment OutcomeABSTRACT
BACKGROUND: Protocols of cardiac magnetic resonance imaging (CMR) during pharmacological stress with adenosine may include scanning sequences for the evaluation of both myocardial perfusion and contractility. The aim of this study was to define the feasibility and diagnostic accuracy of a stress CMR protocol including the combined evaluation of regional myocardial perfusion and contractility in the identification of patients with significant coronary artery disease. METHODS: A total of 184 consecutive patients with known or suspected coronary artery disease underwent stress CMR (adenosine, 140 microg/kg/min). The employed protocol included the application of the following sequences for image acquisition: 1) cine imaging at rest; 2) perfusion imaging (Gd-DTPA, 0.05 mmol/kg) during pharmacological stress; 3) cine imaging during pharmacological stress; 4) perfusion imaging (Gd-DTPA, 0.05 mmol/kg) at rest. RESULTS: Stress CMR was completed in 182 patients (99%). Minor complications were observed in 12 patients (7%) during adenosine infusion, while one patient developed severe bronchospasm and another patient experienced persistent myocardial ischemia. Good/excellent-quality images were obtained in 91% of stress CMR exams. In a subgroup of 37 patients, when compared with the use of perfusion images alone, combination of perfusion and contractility data provided higher levels of sensitivity (74 vs 89%, p < 0.05) and of negative predictive value (71 vs 85%, p < 0.05) in identifying patients with significant coronary artery disease by invasive angiography. CONCLUSIONS: Adenosine stress CMR including the evaluation of both myocardial perfusion and contractility is feasible and improves diagnostic performance in the recognition of patients with significant coronary artery disease.
