Table 2: Prognostic Impact of Cardiac MRI.
| Author | n | Method for Scar Quantification | HR for Adverse Outcome (95% CI) | Result |
|---|---|---|---|---|
| Ischaemic Cardiomyopathy | ||||
| Bello et al. 2005[54] | 48 | ≥2 SD above remote normal myocardium | Not given, p=0.02 | Greater infarct mass and infarct surface area predicts inducible VT at EPS |
| Yan et al. 2006[58] | 144 | ≥2 SD above remote normal myocardium | 1.45 (1.15–1.84) per 10% increase in scar border zone | Extent of the peri-infarct zone defined by delayed-enhancement CMRI is an independent predictor of post-myocardial infarction all-cause and cardiovascular mortality, after adjusting for LV volumes or LVEF |
| Schmidt et al. 2007[119] | 47 | FWHM | Not given, p=0.02 | Border zone mass was higher in those with inducible VT than those with no inducibility, but there was no difference in scar core mass |
| Roes et al. 2009[120] | 91 | FWHM (35-50%) | 1.49 1.01–2.20) per 10 g increase in scar border zone. | Extent of infarct border zone is the strongest predictor of subsequent ICD therapy |
| Kwon et al. 2009[50] | 349 | ≥2 SDs above remote normal myocardium | 1.02 (1.003–1.03) per 1% increase in LV scar | Scar mass predicts mortality or transplantation |
| Kelle et al. 2009[121] | 177 | Number of AHA 17 segment model with enhancement | 1.27 (1.064–1.518) per additional enhanced segment | Number of AHA segments involved predicts death and non-fatal myocardial infarction. |
| Heidary et al. 2010[57] | 70 | FWHM border zone (remote max to 50%), FWHM scar core (>50%) | Not given, p=0.03 | Total scar mass and border zone mass (but not scar core mass) predict adverse outcomes |
| Scott et al. 2011[53] | 64 | The number of transmural scar segments (using AHA 17 segment model) | 1.48 (1.18–1.84) in multivariate analysis | The number of transmural scar segments predicts subsequent ICD therapies |
| Krittayaphong et al. 2011[122] | 1,148 | Visual presence of LGE | 3.92 (1.98–7.76) in multivariate analysis | LGE predicts MACE in a cohort with normal wall motion. |
| Boyé et al. 2011[123] | 52 | ≥5 SD | Not given, p=0.02 | Infarct mass expressed as a percentage of LV mass predicts appropriate device therapy |
| Rubenstein et al. 2013[59] | 47 | Between 2 and 3 SD above remote normal myocardium | 1.97 (1.04–3.73) per 1% change in border zone mass in multivariate analysis | Border zone mass higher in those with VT inducibility (2.64% of LV mass) than those without (1.35%) |
| Alexandre et al. 2013[124] | 49 | Scar mass by manual planimetry | 1.08 (1.04–1.12) unadjusted, 3.15 (1.35-7.33) in multivariate analysis (per 1g extra scar mass) | Scar mass predicts appropriate device therapy |
| Kwon et al. 2014[125] | 450 | ≥2 SD above remote normal myocardium | 1.34 (1.15–1.55) in multivariate analysis | Scar percentage strongly predicts mortality |
| Demirel et al. 2014[126] | 99 | FWHM | 2.01 (1.17–3.44) in multivariate analysis | Ratio of peri-infarct border zone to scar core is associated with appropriate ICD therapy |
| Rijnierse et al. 2016[127] | 52 | FWHM (>50%) | Not given, p=0.07 | Trend towards higher scar burden in those with inducible VT (not significant) |
| Non-ischaemic Cardiomyopathy | ||||
| Assomull et al. 2006[62] | 101 | Visual presence of midwall LGE | 3.4 (1.4–8.7) for presence of LGE | Presence of midwall fibrosis predicts death or hospitalisation |
| Wu et al. 2008[61] | 65 | Visual presence of LGE | 8.2 (2.2–30.9) in multivariate analysis | Presence of LGE predicts cardiovascular death, ICD therapy and HF hospitalisation |
| Iles et al. 2011[128] | 61 | Visual presence of LGE | Not given, p=0.01 | Patients with LGE had significantly higher rates of appropriate ICD therapy |
| Lehrke et al. 2011[129] | 184 | Visual presence of LGE, SD >2 for quantification | 3.5 for presence of scar. 5.28 using threshold of scar >4.4% total LV mass | Presence of LGE predicts cardiac death, ICD therapy or HF hospitalisation |
| Neilan et al. 2013[130] | 162 | Both FWHM and SD methods used | 14.5 (6.1–32.6) for LGE presence, 1.15 (1.12–1.18) for each 1% increase in scar volume | Presence and volume of LGE predicts cardiovascular death or ICD therapy |
| Gulati et al. 2013[131] | 472 | Visual presence, FWHM | 2.96 (1.87–4.69) for presence of LGE, 1.1 (1.06–1.17) per 1% extra LGE | LGE presence, extent predicts mortality, independently of LVEF |
| Machii et al. 2014[132] | 72 | Visual presence of LGE | Not given, p=0.02 for extensive LGE versus no LGE | Lower event-free survival in patients with extensive LGE |
| Perazzolo-Marra et al. 2014[133] | 137 | Visual presence of LGE | 3.8 (1.3–10.4) in multivariate analysis | LGE presence, but not extent, predicts adverse arrhythmic outcome |
| Masci et al. 2014[134] | 228 | Visual presence of LGE | 4.02 (2.08–7.76) in multivariate analysis | LGE presence predicts adverse outcomes in patients with asymptomatic LVSD |
| Piers et al. 2015[68] | 87 | Visual presence, FWHM | 2.71 (1.10–6.69) for LGE presence | LGE predicts monomorphic VT, but not polymorphic VT/VF |
| Shin et al. 2016[135] | 365 | FWHM | 8.45 (2.91–24.6) for LGE extent ≥ 8%, increasing to 6.98 (1.74–28.0) for those with subepicardial pattern of disease | Presence of LGE strongly predicts arrhythmic events, risk varies with location of fibrosis |
| Mueller et al. 2016[136] | 56 | Visual presence of LGE | 1.9 (1.1–3.4) | Presence of LGE predicts VT inducibility |
| Puntmann et al. 2016[137] | 637 | T1 mapping | 1.1 (1.07–1.17) per 10 ms change in T1 time, multivariate analysis | Higher T1 values predict mortality and HF outcomes |
| Halliday et al. 2017[63] | 399 | Visual presence of LGE, FWHM for quantification | 9.2 (3.9–21.8) in patients with LVEF > 40% | A 17.8% event rate (median follow-up 4.6 years) in patients with LGE |
| Halliday et al. 2016[65] | 874 | FWHM | LGE extent of 0 to 2.55%, 2.55% to 5.10%, and >5.10%, respectively, were 1.59 (0.99 to 2.55), 1.56 (0.96 to 2.54), and 2.31 (1.50 to 3.55) for all-cause mortality | The presence and pattern, rather than the extent, of LGE predicts all-cause mortality |
| Studies Including Both ICM and NICM | ||||
| Kwong et al. 2006[138] | 195 | ≥2 SD | 8.29 (3.92–17.5) unadjusted, 8.65 (2.45–30.5) in multivariate analysis | Presence of LGE predicts cardiac events in patients with suspected CAD |
| Klem et al. 2011[51] | 1560 | Number of segments with LGE | 1.007 (1.005–1.009) unadjusted, 1.004 (1.002–1.007) in multivariate analysis | Number of segments with LGE incrementally prediction of all-cause mortality over LVSF and clinic parameters |
| Gao et al. 2012[56] | 124 | ≥2 SD | 1.4 (1.21–1.62) unadjusted | Scar quantification predicts arrhythmic events |
| Dawson et al. 2013[139] | 373 | Visual presence of LGE, FWHM for quantification | 3.5 (2.01–6.13) for presence of LGE, 1.12 per 5% extra LGE | In patients presenting with VT, LGE predicts arrhythmic events |
| Almehmadi et al. 2014[140] | 318 | ≥5 SD | 2.4 (1.2–4.6) in multivariate analysis | Midwall striation predicts sudden death or appropriate ICD therapy |
| Chen et al. 2015[70] | 130 | Native T1 value | 1.1 (1.04–1.16) per 10 ms change in T1 time, multivariate analysis | Myocardial T1 predicts ventricular arrhythmia independently of scar quantification |
| Mordi et al. 2015[141] | 539 | Visual presence of LGE | 2.14 (1.06–4.33) in multivariate analysis | LGE predicts MACE in all-comers attending for CMRI |
| Acosta et al. 2018[60] | 217 | FWHM 40–60% (border zone), >60% (scar core) | 1.06 (1.04–1.08) for border zone mass (g) | Scar mass, border zone mass and border zone channel mass all predict ICD therapy or SCD |
| Olausson et al. 2018[35] | 215 | ECV | 2.17 (1.17–4.00) for each 5% increase in ECV | Diffuse fibrosis (as evidenced by ECV) predicts appropriate ICD therapy |
Studies showing the prognostic effect of CMRI data in ischaemic cardiomyopathy and non-ischaemic cardiomyopathy. AHA = American Heart Association; CMRI = cardiac MRI; EPS = electrophysiology study; ECV = extracellular volume; FWHN = full width at half maximum; HF = heart failure; LGE = late gadolinium enhancement; LV = left ventricle; LVEF = left ventricular ejection fraction; MACE = major adverse cardiac event; VT = ventricular tachycardia.