Prognostic Role of CMR in Patients Presenting With Ventricular Arrhythmias

Dawson, Dana, Hawlisch, Karin, Roussin, Isabelle, Prescott, Gordon orcid iconORCID: 0000-0002-9156-2361, Di Pietro, Elisa, Deac, Monica, Wong, Joyce, Frenneaux, Michael, Pennell, Dudley et al (2013) Prognostic Role of CMR in Patients Presenting With Ventricular Arrhythmias. JACC: Cardiovascular Imaging, 6 (3). pp. 335-344. ISSN 1936-878X

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The goal of this study was to explore whether fibrosis detected by late gadolinium enhancement cardiac magnetic resonance (LGE-CMR) is an independent predictor of hard cardiovascular events in patients presenting with ventricular arrhythmia.

In patients at risk of sudden cardiac death, risk stratification for device therapy remains challenging.

A total of 373 consecutive patients with sustained ventricular tachycardia (VT) (n = 204) or nonsustained ventricular tachycardia (NSVT) (n = 169) underwent LGE-CMR. The group was prospectively followed up for a median of 2.6 years (range 11 months to 11 years). The predetermined endpoint was a composite of cardiac death/arrest, new episode of sustained VT, or appropriate implantable cardioverter-defibrillator discharge.

Mean left ventricular (LV) ejection fraction (EF) was 60 ± 13%. The presence of fibrosis was a strong and independent predictor of the primary outcome for the whole group (hazard ratio [HR]: 3.3, 95% confidence interval [CI]: 1.8 to 5.8, p < 0.001). In the sustained VT subset, both LV fibrosis and severely impaired systolic function (LVEF <35%) were significant independent predictors in the multivariate model (HR: 3.0, 95% CI: 1.4 to 6.2, p = 0.001; and HR: 2.5, 95% CI: 1.1 to 6.2, p = 0.038, respectively). In the NSVT subset, the presence of fibrosis was the only independent predictor of the endpoint (HR: 4.2, 95% CI: 1.7 to 10.1, p = 0.006).

LGE-CMR–detected fibrosis is an independent predictor of adverse outcomes in patients with ventricular arrhythmia and may have an important role in risk stratification.

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