Association between midwall late gadolinium enhancement and sudden cardiac death in patients with dilated cardiomyopathy and mild and moderate left ventricular systolic dysfunction

Brian P. Halliday; Ankur Gulati; Aamir Ali; Kaushik Guha; Simon Newsome; Monika Arzanauskaite; Vassilios S. Vassiliou; Amrit Lota; Cemil Izgi; Upasana Tayal; Zohya Khalique; Colin Stirrat; Dominique Auger; Nilesh Pareek; Tevfik F. Ismail; Stuart D. Rosen; Ali Vazir; Francisco Alpendurada; John Gregson; Michael P. Frenneaux; Martin R. Cowie; John G.F. Cleland; Stuart A. Cook; Dudley J. Pennell; Sanjay K. Prasad

doi:10.1161/CIRCULATIONAHA.116.026910

Association between midwall late gadolinium enhancement and sudden cardiac death in patients with dilated cardiomyopathy and mild and moderate left ventricular systolic dysfunction

Brian P. Halliday, Ankur Gulati, Aamir Ali, Kaushik Guha, Simon Newsome, Monika Arzanauskaite, Vassilios S. Vassiliou, Amrit Lota, Cemil Izgi, Upasana Tayal, Zohya Khalique, Colin Stirrat, Dominique Auger, Nilesh Pareek, Tevfik F. Ismail, Stuart D. Rosen, Ali Vazir, Francisco Alpendurada, John Gregson, Michael P. FrenneauxMartin R. Cowie, John G.F. Cleland, Stuart A. Cook, Dudley J. Pennell^*, Sanjay K. Prasad

^*Corresponding author for this work

Imaging and Biomedical Engineering

Research output: Contribution to journal › Review article › peer-review

270 Citations (Scopus)

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Abstract

Background: Current guidelines only recommend the use of an implantable cardioverter defibrillator in patients with dilated cardiomyopathy for the primary prevention of sudden cardiac death (SCD) in those with a left ventricular ejection fraction (LVEF) <35%. However, registries of out-of-hospital cardiac arrests demonstrate that 70% to 80% of such patients have an LVEF >35%. Patients with an LVEF >35% also have low competing risks of death from nonsudden causes. Therefore, those at high risk of SCD may gain longevity from successful implantable cardioverter defibrillator therapy. We investigated whether late gadolinium enhancement (LGE) cardiovascular magnetic resonance identified patients with dilated cardiomyopathy without severe LV systolic dysfunction at high risk of SCD. Methods: We prospectively investigated the association between midwall LGE and the prespecified primary composite outcome of SCD or aborted SCD among consecutive referrals with dilated cardiomyopathy and an LVEF ≥40% to our center between January 2000 and December 2011 who did not have a preexisting indication for implantable cardioverter defibrillator implantation. Results: Of 399 patients (145 women, median age 50 years, median LVEF 50%, 25.3% with LGE) followed for a median of 4.6 years, 18 of 101 (17.8%) patients with LGE reached the prespecified end point, compared with 7 of 298 (2.3%) without (hazard ratio [HR], 9.2; 95% confidence interval [CI], 3.9-21.8; P<0.0001). Nine patients (8.9%) with LGE compared with 6 (2.0%) without (HR, 4.9; 95% CI, 1.8-13.5; P=0.002) died suddenly, whereas 10 patients (9.9%) with LGE compared with 1 patient (0.3%) without (HR, 34.8; 95% CI, 4.6-266.6; P<0.001) had aborted SCD. After adjustment, LGE predicted the composite end point (HR, 9.3; 95% CI, 3.9-22.3; P<0.0001), SCD (HR, 4.8; 95% CI, 1.7-13.8; P=0.003), and aborted SCD (HR, 35.9; 95% CI, 4.8-271.4; P<0.001). Estimated HRs for the primary end point for patients with an LGE extent of 0% to 2.5%, 2.5% to 5%, and >5% compared with those without LGE were 10.6 (95% CI, 3.9-29.4), 4.9 (95% CI, 1.3-18.9), and 11.8 (95% CI, 4.3-32.3), respectively. Conclusions: Midwall LGE identifies a group of patients with dilated cardiomyopathy and an LVEF ≥40% at increased risk of SCD and low risk of nonsudden death who may benefit from implantable cardioverter defibrillator implantation. Clinical Trial Registration: URL: http://clinicaltrials.gov. Unique identifier: NCT00930735.

Original language	English
Pages (from-to)	2106-2115
Number of pages	10
Journal	Circulation (Baltimore)
Volume	135
Issue number	22
Early online date	28 Mar 2017
DOIs	https://doi.org/10.1161/CIRCULATIONAHA.116.026910
Publication status	Published - 30 May 2017

Keywords

cardiovascular MRI
dilated cardiomyopathy
implantable cardioverter-defibrillator
late gadolinium enhancement
sudden cardiac death

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Halliday, B. P., Gulati, A., Ali, A., Guha, K., Newsome, S., Arzanauskaite, M., Vassiliou, V. S., Lota, A., Izgi, C., Tayal, U., Khalique, Z., Stirrat, C., Auger, D., Pareek, N., Ismail, T. F., Rosen, S. D., Vazir, A., Alpendurada, F., Gregson, J., ... Prasad, S. K. (2017). Association between midwall late gadolinium enhancement and sudden cardiac death in patients with dilated cardiomyopathy and mild and moderate left ventricular systolic dysfunction. Circulation (Baltimore), 135(22), 2106-2115. https://doi.org/10.1161/CIRCULATIONAHA.116.026910

@article{86a0f98d8c134fa79fa8fc2f6d25cac5,

title = "Association between midwall late gadolinium enhancement and sudden cardiac death in patients with dilated cardiomyopathy and mild and moderate left ventricular systolic dysfunction",

abstract = "Background: Current guidelines only recommend the use of an implantable cardioverter defibrillator in patients with dilated cardiomyopathy for the primary prevention of sudden cardiac death (SCD) in those with a left ventricular ejection fraction (LVEF) <35%. However, registries of out-of-hospital cardiac arrests demonstrate that 70% to 80% of such patients have an LVEF >35%. Patients with an LVEF >35% also have low competing risks of death from nonsudden causes. Therefore, those at high risk of SCD may gain longevity from successful implantable cardioverter defibrillator therapy. We investigated whether late gadolinium enhancement (LGE) cardiovascular magnetic resonance identified patients with dilated cardiomyopathy without severe LV systolic dysfunction at high risk of SCD. Methods: We prospectively investigated the association between midwall LGE and the prespecified primary composite outcome of SCD or aborted SCD among consecutive referrals with dilated cardiomyopathy and an LVEF ≥40% to our center between January 2000 and December 2011 who did not have a preexisting indication for implantable cardioverter defibrillator implantation. Results: Of 399 patients (145 women, median age 50 years, median LVEF 50%, 25.3% with LGE) followed for a median of 4.6 years, 18 of 101 (17.8%) patients with LGE reached the prespecified end point, compared with 7 of 298 (2.3%) without (hazard ratio [HR], 9.2; 95% confidence interval [CI], 3.9-21.8; P<0.0001). Nine patients (8.9%) with LGE compared with 6 (2.0%) without (HR, 4.9; 95% CI, 1.8-13.5; P=0.002) died suddenly, whereas 10 patients (9.9%) with LGE compared with 1 patient (0.3%) without (HR, 34.8; 95% CI, 4.6-266.6; P<0.001) had aborted SCD. After adjustment, LGE predicted the composite end point (HR, 9.3; 95% CI, 3.9-22.3; P<0.0001), SCD (HR, 4.8; 95% CI, 1.7-13.8; P=0.003), and aborted SCD (HR, 35.9; 95% CI, 4.8-271.4; P<0.001). Estimated HRs for the primary end point for patients with an LGE extent of 0% to 2.5%, 2.5% to 5%, and >5% compared with those without LGE were 10.6 (95% CI, 3.9-29.4), 4.9 (95% CI, 1.3-18.9), and 11.8 (95% CI, 4.3-32.3), respectively. Conclusions: Midwall LGE identifies a group of patients with dilated cardiomyopathy and an LVEF ≥40% at increased risk of SCD and low risk of nonsudden death who may benefit from implantable cardioverter defibrillator implantation. Clinical Trial Registration: URL: http://clinicaltrials.gov. Unique identifier: NCT00930735.",

keywords = "cardiovascular MRI, dilated cardiomyopathy, implantable cardioverter-defibrillator, late gadolinium enhancement, sudden cardiac death",

author = "Halliday, {Brian P.} and Ankur Gulati and Aamir Ali and Kaushik Guha and Simon Newsome and Monika Arzanauskaite and Vassiliou, {Vassilios S.} and Amrit Lota and Cemil Izgi and Upasana Tayal and Zohya Khalique and Colin Stirrat and Dominique Auger and Nilesh Pareek and Ismail, {Tevfik F.} and Rosen, {Stuart D.} and Ali Vazir and Francisco Alpendurada and John Gregson and Frenneaux, {Michael P.} and Cowie, {Martin R.} and Cleland, {John G.F.} and Cook, {Stuart A.} and Pennell, {Dudley J.} and Prasad, {Sanjay K.}",

year = "2017",

month = may,

day = "30",

doi = "10.1161/CIRCULATIONAHA.116.026910",

language = "English",

volume = "135",

pages = "2106--2115",

journal = "Circulation (Baltimore)",

issn = "0009-7322",

publisher = "American Heart Association, Inc.",

number = "22",

}

Halliday, BP, Gulati, A, Ali, A, Guha, K, Newsome, S, Arzanauskaite, M, Vassiliou, VS, Lota, A, Izgi, C, Tayal, U, Khalique, Z, Stirrat, C, Auger, D, Pareek, N, Ismail, TF, Rosen, SD, Vazir, A, Alpendurada, F, Gregson, J, Frenneaux, MP, Cowie, MR, Cleland, JGF, Cook, SA, Pennell, DJ & Prasad, SK 2017, 'Association between midwall late gadolinium enhancement and sudden cardiac death in patients with dilated cardiomyopathy and mild and moderate left ventricular systolic dysfunction', Circulation (Baltimore), vol. 135, no. 22, pp. 2106-2115. https://doi.org/10.1161/CIRCULATIONAHA.116.026910

Association between midwall late gadolinium enhancement and sudden cardiac death in patients with dilated cardiomyopathy and mild and moderate left ventricular systolic dysfunction. / Halliday, Brian P.; Gulati, Ankur; Ali, Aamir et al.
In: Circulation (Baltimore), Vol. 135, No. 22, 30.05.2017, p. 2106-2115.

Research output: Contribution to journal › Review article › peer-review

TY - JOUR

T1 - Association between midwall late gadolinium enhancement and sudden cardiac death in patients with dilated cardiomyopathy and mild and moderate left ventricular systolic dysfunction

AU - Halliday, Brian P.

AU - Gulati, Ankur

AU - Ali, Aamir

AU - Guha, Kaushik

AU - Newsome, Simon

AU - Arzanauskaite, Monika

AU - Vassiliou, Vassilios S.

AU - Lota, Amrit

AU - Izgi, Cemil

AU - Tayal, Upasana

AU - Khalique, Zohya

AU - Stirrat, Colin

AU - Auger, Dominique

AU - Pareek, Nilesh

AU - Ismail, Tevfik F.

AU - Rosen, Stuart D.

AU - Vazir, Ali

AU - Alpendurada, Francisco

AU - Gregson, John

AU - Frenneaux, Michael P.

AU - Cowie, Martin R.

AU - Cleland, John G.F.

AU - Cook, Stuart A.

AU - Pennell, Dudley J.

AU - Prasad, Sanjay K.

PY - 2017/5/30

Y1 - 2017/5/30

N2 - Background: Current guidelines only recommend the use of an implantable cardioverter defibrillator in patients with dilated cardiomyopathy for the primary prevention of sudden cardiac death (SCD) in those with a left ventricular ejection fraction (LVEF) <35%. However, registries of out-of-hospital cardiac arrests demonstrate that 70% to 80% of such patients have an LVEF >35%. Patients with an LVEF >35% also have low competing risks of death from nonsudden causes. Therefore, those at high risk of SCD may gain longevity from successful implantable cardioverter defibrillator therapy. We investigated whether late gadolinium enhancement (LGE) cardiovascular magnetic resonance identified patients with dilated cardiomyopathy without severe LV systolic dysfunction at high risk of SCD. Methods: We prospectively investigated the association between midwall LGE and the prespecified primary composite outcome of SCD or aborted SCD among consecutive referrals with dilated cardiomyopathy and an LVEF ≥40% to our center between January 2000 and December 2011 who did not have a preexisting indication for implantable cardioverter defibrillator implantation. Results: Of 399 patients (145 women, median age 50 years, median LVEF 50%, 25.3% with LGE) followed for a median of 4.6 years, 18 of 101 (17.8%) patients with LGE reached the prespecified end point, compared with 7 of 298 (2.3%) without (hazard ratio [HR], 9.2; 95% confidence interval [CI], 3.9-21.8; P<0.0001). Nine patients (8.9%) with LGE compared with 6 (2.0%) without (HR, 4.9; 95% CI, 1.8-13.5; P=0.002) died suddenly, whereas 10 patients (9.9%) with LGE compared with 1 patient (0.3%) without (HR, 34.8; 95% CI, 4.6-266.6; P<0.001) had aborted SCD. After adjustment, LGE predicted the composite end point (HR, 9.3; 95% CI, 3.9-22.3; P<0.0001), SCD (HR, 4.8; 95% CI, 1.7-13.8; P=0.003), and aborted SCD (HR, 35.9; 95% CI, 4.8-271.4; P<0.001). Estimated HRs for the primary end point for patients with an LGE extent of 0% to 2.5%, 2.5% to 5%, and >5% compared with those without LGE were 10.6 (95% CI, 3.9-29.4), 4.9 (95% CI, 1.3-18.9), and 11.8 (95% CI, 4.3-32.3), respectively. Conclusions: Midwall LGE identifies a group of patients with dilated cardiomyopathy and an LVEF ≥40% at increased risk of SCD and low risk of nonsudden death who may benefit from implantable cardioverter defibrillator implantation. Clinical Trial Registration: URL: http://clinicaltrials.gov. Unique identifier: NCT00930735.

AB - Background: Current guidelines only recommend the use of an implantable cardioverter defibrillator in patients with dilated cardiomyopathy for the primary prevention of sudden cardiac death (SCD) in those with a left ventricular ejection fraction (LVEF) <35%. However, registries of out-of-hospital cardiac arrests demonstrate that 70% to 80% of such patients have an LVEF >35%. Patients with an LVEF >35% also have low competing risks of death from nonsudden causes. Therefore, those at high risk of SCD may gain longevity from successful implantable cardioverter defibrillator therapy. We investigated whether late gadolinium enhancement (LGE) cardiovascular magnetic resonance identified patients with dilated cardiomyopathy without severe LV systolic dysfunction at high risk of SCD. Methods: We prospectively investigated the association between midwall LGE and the prespecified primary composite outcome of SCD or aborted SCD among consecutive referrals with dilated cardiomyopathy and an LVEF ≥40% to our center between January 2000 and December 2011 who did not have a preexisting indication for implantable cardioverter defibrillator implantation. Results: Of 399 patients (145 women, median age 50 years, median LVEF 50%, 25.3% with LGE) followed for a median of 4.6 years, 18 of 101 (17.8%) patients with LGE reached the prespecified end point, compared with 7 of 298 (2.3%) without (hazard ratio [HR], 9.2; 95% confidence interval [CI], 3.9-21.8; P<0.0001). Nine patients (8.9%) with LGE compared with 6 (2.0%) without (HR, 4.9; 95% CI, 1.8-13.5; P=0.002) died suddenly, whereas 10 patients (9.9%) with LGE compared with 1 patient (0.3%) without (HR, 34.8; 95% CI, 4.6-266.6; P<0.001) had aborted SCD. After adjustment, LGE predicted the composite end point (HR, 9.3; 95% CI, 3.9-22.3; P<0.0001), SCD (HR, 4.8; 95% CI, 1.7-13.8; P=0.003), and aborted SCD (HR, 35.9; 95% CI, 4.8-271.4; P<0.001). Estimated HRs for the primary end point for patients with an LGE extent of 0% to 2.5%, 2.5% to 5%, and >5% compared with those without LGE were 10.6 (95% CI, 3.9-29.4), 4.9 (95% CI, 1.3-18.9), and 11.8 (95% CI, 4.3-32.3), respectively. Conclusions: Midwall LGE identifies a group of patients with dilated cardiomyopathy and an LVEF ≥40% at increased risk of SCD and low risk of nonsudden death who may benefit from implantable cardioverter defibrillator implantation. Clinical Trial Registration: URL: http://clinicaltrials.gov. Unique identifier: NCT00930735.

KW - cardiovascular MRI

KW - dilated cardiomyopathy

KW - implantable cardioverter-defibrillator

KW - late gadolinium enhancement

KW - sudden cardiac death

UR - http://www.scopus.com/inward/record.url?scp=85018833039&partnerID=8YFLogxK

U2 - 10.1161/CIRCULATIONAHA.116.026910

DO - 10.1161/CIRCULATIONAHA.116.026910

M3 - Review article

AN - SCOPUS:85018833039

SN - 0009-7322

VL - 135

SP - 2106

EP - 2115

JO - Circulation (Baltimore)

JF - Circulation (Baltimore)

IS - 22

ER -

Association between midwall late gadolinium enhancement and sudden cardiac death in patients with dilated cardiomyopathy and mild and moderate left ventricular systolic dysfunction

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