Prognostic Benefit of Cardiac Magnetic Resonance Over Transthoracic Echocardiography for the Assessment of Ischemic and Nonischemic Dilated Cardiomyopathy Patients Referred for the Evaluation of Primary Prevention Implantable Cardioverter-Defibrillator Therapy

Circ Cardiovasc Imaging. 2016 Oct;9(10):e004956. doi: 10.1161/CIRCIMAGING.115.004956.

Abstract

Background: The aim of this study was to determine the prognostic benefit of cardiac magnetic resonance (CMR) over transthoracic echocardiography (TTE) in ischemic cardiomyopathy and nonischemic dilated cardiomyopathy patients evaluated for primary prevention implantable cardioverter-defibrillator therapy.

Methods and results: We enrolled 409 consecutive ischemic and dilated cardiomyopathy patients (mean age: 64±12 years; 331 men). All patients underwent TTE and CMR, and left ventricle end-diastolic volume, left ventricle end-systolic volume, and left ventricle ejection fraction (LVEF) were evaluated. In addition, late gadolinium enhancement was also assessed. All patients were followed up for major adverse cardiac events (MACE) defined as a composite end point of long runs of nonsustained ventricular tachycardia, sustained ventricular tachycardia, aborted sudden cardiac death, or sudden cardiac death. The median follow-up was 545 days. CMR showed higher left ventricle end-diastolic volume (mean difference: 43±22.5 mL), higher left ventricle end-systolic volume (mean difference: 34±20.5 mL), and lower LVEF (mean difference: -4.9±10%) as compared to TTE (P<0.01). MACE occurred in 103 (25%) patients. Patients experiencing MACE showed higher left ventricle end-diastolic volume, higher left ventricle end-systolic volume, and lower LVEF with both imaging modalities and higher late gadolinium enhancement per-patient prevalence as compared to patients without MACE. At multivariable analysis, CMR-LVEF ≤35% (hazard ratio=2.18 [1.3-3.8]) and the presence of late gadolinium enhancement (hazard ratio=2.2 [1.4-3.6]) were independently associated with MACE (P<0.01). A model based on CMR-LVEF ≤35% or CMR-LVEF ≤35% plus late gadolinium enhancement detection showed a higher performance in the prediction of MACE as compared to TTE-LVEF resulting in net reclassification improvement of 0.468 (95% confidence interval, 0.283-0.654; P<0.001) and 0.413 (95% confidence interval, 0.23-0.63; P<0.001), respectively.

Conclusions: CMR provides additional prognostic stratification as compared to TTE, which may have direct impact on the indication of implantable cardioverter-defibrillator implantation.

Keywords: dilated cardiomyopathy; echocardiography; magnetic resonance; primary prevention; prognosis.

Publication types

  • Comparative Study

MeSH terms

  • Aged
  • Arrhythmias, Cardiac / etiology
  • Arrhythmias, Cardiac / prevention & control
  • Cardiomyopathy, Dilated / diagnostic imaging*
  • Cardiomyopathy, Dilated / etiology
  • Cardiomyopathy, Dilated / physiopathology
  • Cardiomyopathy, Dilated / therapy*
  • Chi-Square Distribution
  • Contrast Media / administration & dosage
  • Death, Sudden, Cardiac / etiology
  • Death, Sudden, Cardiac / prevention & control
  • Defibrillators, Implantable*
  • Echocardiography / methods*
  • Electric Countershock / instrumentation*
  • Female
  • Humans
  • Kaplan-Meier Estimate
  • Magnetic Resonance Imaging, Cine*
  • Male
  • Meglumine / administration & dosage
  • Meglumine / analogs & derivatives
  • Middle Aged
  • Multivariate Analysis
  • Myocardial Ischemia / complications*
  • Myocardial Ischemia / diagnostic imaging
  • Myocardial Ischemia / physiopathology
  • Organometallic Compounds / administration & dosage
  • Predictive Value of Tests
  • Primary Prevention / instrumentation*
  • Primary Prevention / methods
  • Proportional Hazards Models
  • Referral and Consultation*
  • Risk Factors
  • Stroke Volume
  • Ventricular Function, Left

Substances

  • Contrast Media
  • Organometallic Compounds
  • gadobenic acid
  • Meglumine