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Meta-Analysis
. 2017 Jan;5(1):28-38.
doi: 10.1016/j.jchf.2016.09.017. Epub 2016 Dec 21.

Late Gadolinium Enhancement and the Risk for Ventricular Arrhythmias or Sudden Death in Dilated Cardiomyopathy: Systematic Review and Meta-Analysis

Andrea Di Marco  1 , Ignasi Anguera  2 , Matthias Schmitt  3 , Igor Klem  4 , Tomas G Neilan  5 , James A White  6 , Marek Sramko  7 , Pier Giorgio Masci  8 , Andrea Barison  9 , Peter Mckenna  10 , Ify Mordi  11 , Kristina H Haugaa  12 , Francisco Leyva  13 , Jorge Rodriguez Capitán  14 , Hiroshi Satoh  15 , Takeru Nabeta  16 , Paolo Domenico Dallaglio  2 , Niall G Campbell  3 , Xavier Sabaté  2 , Ángel Cequier  2
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Free article
Meta-Analysis

Late Gadolinium Enhancement and the Risk for Ventricular Arrhythmias or Sudden Death in Dilated Cardiomyopathy: Systematic Review and Meta-Analysis

Andrea Di Marco et al. JACC Heart Fail. 2017 Jan.
Free article

Erratum in

  • Correction.
    [No authors listed] [No authors listed] JACC Heart Fail. 2017 Apr;5(4):316. doi: 10.1016/j.jchf.2017.02.006. JACC Heart Fail. 2017. PMID: 28359423 No abstract available.

Abstract

Objectives: The aim of this study was to evaluate the association between late gadolinium enhancement (LGE) on cardiac magnetic resonance imaging and ventricular arrhythmias or sudden cardiac death (SCD) in patients with dilated cardiomyopathy (DCM).

Background: Risk stratification for SCD in DCM needs to be improved.

Methods: A systematic review and meta-analysis were conducted. A systematic search of PubMed and Ovid was performed, and observational studies that analyzed the arrhythmic endpoint (sustained ventricular arrhythmia, appropriate implantable cardioverter-defibrillator [ICD] therapy, or SCD) in patients with DCM, stratified by the presence or absence of LGE, were included.

Results: Twenty-nine studies were included, accounting for 2,948 patients. The studies covered a wide spectrum of DCM, with a mean left ventricular ejection fraction between 20% and 43%. LGE was significantly associated with the arrhythmic endpoint both in the overall population (odds ratio: 4.3; p < 0.001) and when including only those studies that performed multivariate analysis (hazard ratio: 6.7; p < 0.001). The association between LGE and the arrhythmic endpoint remained significant among studies with mean left ventricular ejection fractions >35% (odds ratio: 5.2; p < 0.001) and was maximal in studies that included only patients with primary prevention ICDs (odds ratio: 7.8; p = 0.008).

Conclusions: Across a wide spectrum of patients with DCM, LGE is strongly and independently associated with ventricular arrhythmia or SCD. LGE could be a powerful tool to improve risk stratification for SCD in patients with DCM. These results raise 2 major questions to be addressed in future studies: whether patients with LGE could benefit from primary prevention ICDs irrespective of their left ventricular ejection fractions, while patients without LGE might not need preventive ICDs despite having severe left ventricular dysfunction.

Keywords: cardiac magnetic resonance; dilated cardiomyopathy; late gadolinium enhancement; sudden death; ventricular arrhythmias.

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