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Prognostic Value of Late Gadolinium Enhancement for the Prediction of Cardiovascular Outcomes in Dilated Cardiomyopathy: An International, Multi-Institutional Study of the MINICOR Group

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  • Ana Carolina Alba
  • Juan Gaztañaga
  • Farid Foroutan
  • Paaladinesh Thavendiranathan
  • Marco Merlo
  • David Alonso-Rodriguez
  • Victor Vallejo-García
  • Rafael Vidal-Perez
  • Cecilia Corros-Vicente
  • Manuel Barreiro-Pérez
  • Pablo Pazos-López
  • Esther Perez-David
  • Steven Dykstra
  • Jacqueline Flewitt
  • José Ángel Pérez-Rivera
  • Maria Vazquez-Caamaño
  • Stuart D Katz
  • Gianfranco Sinagra
  • Lars Køber
  • Jeanne Poole
  • Heather Ross
  • Michael E Farkouh
  • James A White
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BACKGROUND: Dilated cardiomyopathy is associated with increased risk of major cardiovascular events. Late gadolinium enhancement (LGE) cardiac magnetic resonance imaging is a unique tissue-based marker that, in single-center studies, suggests strong prognostic value. We retrospectively studied associations between LGE presence and adverse cardiovascular events in patients with dilated cardiomyopathy in a multicenter setting as part of an emerging global consortium (MINICOR [Multi-Modal International Cardiovascular Outcomes Registry]).

METHODS: Consecutive patients with dilated cardiomyopathy referred for cardiac magnetic resonance (2000-2017) at 12 institutions in 4 countries were studied. Using multivariable Cox proportional hazard and semiparametric Fine and Gray models, we evaluated the association between LGE and the composite primary end point of all-cause mortality, heart transplantation, or left ventricular assist device implant and a secondary arrhythmic end point of sudden cardiac death or appropriate implantable cardioverter-defibrillator shock.

RESULTS: We studied 1672 patients, mean age 56±14 years (29% female), left ventricular ejection fraction 33±11%, and 25% having New York Heart Association class III to IV; 650 patients (39%) had LGE. During 2.3 years (interquartile range, 1.0-4.3) follow-up, 160 patients experienced the primary end point, and 88 experienced the arrhythmic end point. In multivariable analyses, LGE was associated with 1.5-fold (hazard ratio, 1.45 [95% CI, 1.03-2.04]) risk of the primary end point and 1.8-fold (hazard ratio, 1.82 [95% CI, 1.20-3.06]) risk of the arrhythmic end point. Primary end point risk was increased in patients with multiple LGE patterns, although arrhythmic risk was higher among patients receiving primary prevention implantable cardioverter-defibrillator and widening QRS.

CONCLUSIONS: In this large multinational study of patients with dilated cardiomyopathy, the presence of LGE showed strong prognostic value for identification of high-risk patients. Randomized controlled trials evaluating LGE-based care management strategies are warranted.

OriginalsprogEngelsk
TidsskriftCirculation. Cardiovascular Imaging
Vol/bind13
Udgave nummer4
Sider (fra-til)e010105
ISSN1941-9651
DOI
StatusUdgivet - apr. 2020

ID: 62248874