Table 2.
Assessment of arrhythmogenic substrate with CMR and advanced echocardiography in nonischemic cardiomyopathies
| Imaging technique | Study | No. | Cardiomyopathy | Parameter | Evidence |
|---|---|---|---|---|---|
| LGE CMR | Wu et al.27 | 65 | DCM | Presence of LGE | Patients with LGE presented more frequently with cardiac death or appropriate ICD therapy (22% vs 8%, P = 0.03) Presence of LGE was independently associated with heart failure hospitalization, cardiac death, or appropriate ICD therapy (HR 8.2, 95% CI 2.2-30.9; P = 0.002) |
| Iles et al.28 | 61 | NA | Presence of LGE | Patients with LGE showed significantly higher rates of appropriate ICD therapies compared with patients without LGE (29% vs 0%, P < 0.001) | |
| Lehrke et al.29 | 184 | DCM | Presence of LGE Extent of LGE |
Presence of LGE was associated with 3.4-fold increased risk of combined end point (cardiac death, appropriate ICD therapy, and heart failure hospitalization) (95% CI 1.26–9, P = 0.015) Patients with LGE extending ≥4.4% of the LV mass showed an increased rate in the combined end point |
|
| Gao et al.30 | 65 | Myocarditis (n = 8) Sarcoidosis (n = 6) Chemotherapy (n = 3) ARVC (n = 1) NA (n = 47) |
Extent of LGE | Patients with scar mass above the median value (20.8 g) showed higher cumulative risk of appropriate ICD therapy, survived cardiac arrest or SCD than their counterparts (HR 1.8, 95% CI 0.4–7.6; P = 0.4) | |
| Muller et al.31 | 185 | DCM (n = 102) Myocarditis (n = 65) HCM (n = 15) Storage disease (n = 3) |
Presence of LGE | Patients with LGE showed higher cumulative 3-year event rates (composite end point including appropriate ICD and sustained ventricular arrhythmias) than their counterparts (67% vs 27%; P = 0.021). However, presence of LGE was not independently associated with outcome (HR 1.1, 95% CI 0.6–2.1; P = 0.67) | |
| Gulati et al.32 | 472 | DCM | Presence of LGE Extent of LGE |
Patients with mid-wall LGE were 5 times more likely to present with SCD or aborted SCD compared with patients without (29.6% vs 7%). Each 1% increment in LGE extent was independently associated with arrhythmic outcome (HR 1.10, 95% CI 1.05–1.16; P < 0.001) | |
| Neilan et al.33 | 162 | NA (infiltrative cardiomyopathy excluded) |
Presence of LGE Extent of LGE |
Presence of LGE (HR 14, 95% CI 4.4-45.6; p<0.001) and each 1% increment in LGE extent (HR 1.17, 95% CI 1.12–1.22; P < 0.0001) were strongly associated with appropriate ICD therapy or non-heart failure cardiac death | |
| Masci et al.34 | 228 | DCM Chemotherapy (n=7) |
Presence of LGE | Patients with LGE showed 8.3-fold higher risk of aborted SCD versus patients without LGE (95% CI 1.66–41.55; P = 0.01) | |
| Grün et al.35 | 222 | Myocarditis | Presence of LGE Extent of LGE |
LGE was more frequently observed among patients who presented with SCD compared with patients without event (100% vs 43%; P < 0.001). Presence of LGE was independently associated with cardiac death (HR 12.8; P < 0.01) | |
| Mello et al.36 | 41 | Chagas cardiomyopathy | Presence of LGE Extent of LGE |
The presence of ≥2 LV segments with transmural scar was independently associated with ventricular arrhythmias (relative risk 4.1; 95% CI 1.06–15.68; P = 0.04) | |
| Kramer et al.37 | 57 | Anderson-Fabry’s disease | Presence of LGE Progression of LGE |
Only patients with LGE presented with ventricular arrhythmic events. Annual increase in fibrosis (LGE) was the only independent predictor of ventricular arrhythmias (P = 0.038) | |
| Florian et al.38 | 88 | Duchnne and Becker muscular dystrophies | Presence of LGE | Presence of transmural LGE was independently associated with heart failure hospitalizations or ventricular arrhythmias (HR 2.89, 95% CI 1.09–7.68; P = 0.033) | |
| Greulich et al.39 | 155 | Sarcoidosis | Presence of LGE | Patients with LGE had 31.6-fold increased risk of presenting with death, aborted SCD, or appropriate ICD therapy (P = 0.0014) | |
| Murtagh et al.40 | 205 | Sarcoidosis | Presence of LGE Extent of LGE |
The annualized rate of death or ventricular tachycardia was significantly higher among patients with LGE compared with patients without (4.93% vs 0.24%, P < 0.05). Each 1% increase in LGE extent resulted in 8% increase in the hazard of death or ventricular tachycardia | |
| Speckle tracking echocardiography | Joyce et al.41 | 100 | Sarcoidosis | Global LV longitudinal strain | Global LV longitudinal strain was independently associated with 1.4-fold increased risk of composite end point (including arrhythmias) |
| Haugaa et al.42 | 94 | DCM | Global LV longitudinal strain Mechanical dispersion |
Each 1% worsening in global LV longitudinal strain was independently associated with ventricular arrhythmias, SCD and appropriate ICD therapy (HR 1.26, 95% CI 1.03–1.54; P = 0.02) Each 10 ms increment in mechanical dispersion was associated with a 1.20 increased risk for ventricular arrhythmias, SCD, and appropriate ICD therapy (95% CI 1.03–1.4; P = 0.02) |
ARVC arrhythmogenic right ventricular cardiomyopathy, DCM dilated cardiomyopathy, CI confidence interval, CMR cardiac magnetic resonance, HCM hypertrophic cardiomyopathy, HR hazard ratio, LGE late gadolinium enhancement, LV left ventricular, NA not available, SCD sudden cardiac death