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Pattern of late gadolinium enhancement predicts arrhythmic events in patients with non-ischemic cardiomyopathy

 Dong Geum Shin  ;  Hye-Jeong Lee  ;  Junbeom Park  ;  Jae-Sun Uhm  ;  Hui-Nam Pak  ;  Moon-Hyoung Lee  ;  Young Jin Kim  ;  Boyoung Joung 
 International Journal of Cardiology, Vol.222 : 9-15, 2016 
Journal Title
 International Journal of Cardiology 
Issue Date
Adult ; Aged ; Arrhythmias, Cardiac/diagnosis* ; Arrhythmias, Cardiac/etiology ; Arrhythmias, Cardiac/mortality ; Arrhythmias, Cardiac/therapy ; Cardiomyopathies*/complications ; Cardiomyopathies*/diagnosis ; Cardiomyopathies*/physiopathology ; Death, Sudden, Cardiac/epidemiology ; Death, Sudden, Cardiac/prevention & control ; Female ; Gadolinium/pharmacology ; Heart Ventricles*/drug effects ; Heart Ventricles*/physiopathology ; Humans ; Image Enhancement/methods ; Magnetic Resonance Imaging, Cine/methods ; Male ; Middle Aged ; Predictive Value of Tests ; Prognosis ; Radioisotopes ; Republic of Korea/epidemiology ; Risk Assessment/methods
Arrhythmic events ; Cardiac MRI ; Late gadolinium enhancement ; Nonischemic cardiomyopathy ; Predictor
BACKGROUND: Left ventricular late gadolinium enhancement (LV-LGE) by cardiac magnetic resonance (CMR) imaging has been associated with adverse clinical outcomes in patients with non-ischemic cardiomyopathy (NICM). However, an association between the characteristics of the LGE and arrhythmic risk has not been demonstrated consistently. This study evaluated the impact of the LV-LGE characteristics on the arrhythmia risk in patients with NICM. METHODS: This study enrolled 365 consecutive patients (54±15years) with NICM who underwent CMR imaging. All patients were monitored for the following outcomes: major arrhythmic events (MA), including sustained ventricular tachycardia, an appropriate implantable cardioverter-defibrillator intervention, ventricular fibrillation and sudden cardiac death. RESULTS: During 44.3±36.4months of follow-up, 44 (12.1%) patients experienced MA. LV-LGE was observed in 40 (90.9%) and 221 (68.8%) patients with and without MA, respectively. LV-LGE was more frequently observed in the MA group (p=0.002). The age- and sex-adjusted hazard ratio (HR) of MA was increased in patients with LGE extent≥8% (HR 8.45, 95% confidence interval (CI) 2.91-24.6), and those with subendocardial (HR 6.98, 95% CI 1.74-28.0) and subepicardial LGE patterns (HR 7.2, 95% CI 1.61-35.6). In multivariable models adjusted for other clinical variables, only the subepicardial LGE pattern had 7.2 (95% CI, 1.61-32.6, p=0.01) time increase in the MA risk. CONCLUSIONS: LV-LGE in patients with NICM is not uncommon. The subepicardial pattern of the LV-LGE was an independent predictor of MA, suggesting that specific patterns of the LV-LGE are closely related to the severity of arrhythmic events.
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1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
김영진(Kim, Young Jin) ORCID logo https://orcid.org/0000-0002-6235-6550
박희남(Pak, Hui Nam) ORCID logo https://orcid.org/0000-0002-3256-3620
신동금(Shin, Dong Geum)
엄재선(Uhm, Jae Sun) ORCID logo https://orcid.org/0000-0002-1611-8172
이문형(Lee, Moon Hyoung) ORCID logo https://orcid.org/0000-0002-7268-0741
이혜정(Lee, Hye Jeong) ORCID logo https://orcid.org/0000-0003-4349-9174
정보영(Joung, Bo Young) ORCID logo https://orcid.org/0000-0001-9036-7225
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