Prevalence and prognostic significance of ischemic late gadolinium enhancement pattern in non-ischemic dilated cardiomyopathy

• Published in: The American heart journal 2022-04, Vol.246, p.117-124
• Main Authors: De Angelis, Giulia, De Luca, Antonio, Merlo, Marco, Nucifora, Gaetano, Rossi, Maddalena, Stolfo, Davide, Barbati, Giulia, De Bellis, Annamaria, Masè, Marco, Santangeli, Pasquale, Pagnan, Lorenzo, Muser, Daniele, Sinagra, Gianfranco
• Format: Article
• Language: English
• Subjects: Cardiac arrhythmia; Cardiomyopathy; Cardiomyopathy, Dilated - diagnostic imaging; Cardiomyopathy, Dilated - epidemiology; Cardiovascular disease; Congestive heart failure; Contrast Media; Coronary artery; Coronary artery disease; Death; Dilated cardiomyopathy; Fibrillation; Flutter; Gadolinium; Heart transplantation; Humans; Hypertension; Implantation; Ischemia; Magnetic resonance; Magnetic Resonance Imaging, Cine; Medical prognosis; Mortality; Myocardial infarction; Predictive Value of Tests; Prevalence; Prognosis; Retrospective Studies; Statistical analysis; Transplantation; Transplants & implants; Variance analysis; Ventricle
• ISSN: 0002-8703; 1097-6744
• DOI: 10.1016/j.ahj.2022.01.006

Typical late gadolinium enhancement (LGE) patterns in dilated cardiomyopathy (DCM) include intramyocardial and subepicardial distribution. However, the ischemic pattern of LGE (subendocardial and transmural) has also been reported in DCM without coronary artery disease (CAD), but its correlates and prognostic significance are still not known. On these bases, this study sought to describe the prevalence and prognostic significance of the ischemic LGE pattern in DCM. A total of 611 DCM patients with available cardiac magnetic resonance were retrospectively analyzed. A composite of all-cause-death, major ventricular arrhythmias (MVAs), heart transplantation (HTx) or ventricular assist device (VAD) implantation was the primary outcome of the study. Secondary outcomes were a composite of sudden cardiac death or MVAs and a composite of death for refractory heart failure, HTx or VAD implantation. Ischemic LGE was found in 7% of DCM patients without significant CAD or history of myocardial infarction, most commonly inferior/inferolateral/anterolateral. Compared to patients with non-ischemic LGE, those with ischemic LGE had higher prevalence of hypertension and atrial fibrillation or flutter. Ischemic LGE was associated with worse long-term outcomes compared to non-ischemic LGE (36% vs 23% risk of primary outcome events at 5 years respectively, P = .006), and remained an independent predictor of primary outcome after adjustment for clinically and statistically significant variables (adjusted hazard ratio 2.059 [1.055-4.015], P = .034 with respect to non-ischemic LGE). The ischemic pattern of LGE is not uncommon among DCM patients without CAD and is independently associated with worse long-term outcomes. [Display omitted]