title: Prognostic role of CMR in patients presenting with ventricular arrhythmias.
abstract: OBJECTIVE
  The goal of this study was to explore whether fibrosis detected by late gadolinium enhancement cardiac magnetic resonance (LGE-CMR) is an independent predictor of hard cardiovascular events in patients presenting with ventricular arrhythmia.
  
  
  BACKGROUND
  In patients at risk of sudden cardiac death, risk stratification for device therapy remains challenging.
  
  
  METHODS
  A total of 373 consecutive patients with sustained ventricular tachycardia (VT) (n = 204) or nonsustained ventricular tachycardia (NSVT) (n = 169) underwent LGE-CMR. The group was prospectively followed up for a median of 2.6 years (range 11 months to 11 years). The predetermined endpoint was a composite of cardiac death/arrest, new episode of sustained VT, or appropriate implantable cardioverter-defibrillator discharge.
  
  
  RESULTS
  Mean left ventricular (LV) ejection fraction (EF) was 60 ± 13%. The presence of fibrosis was a strong and independent predictor of the primary outcome for the whole group (hazard ratio [HR]: 3.3, 95% confidence interval [CI]: 1.8 to 5.8, p < 0.001). In the sustained VT subset, both LV fibrosis and severely impaired systolic function (LVEF <35%) were significant independent predictors in the multivariate model (HR: 3.0, 95% CI: 1.4 to 6.2, p = 0.001; and HR: 2.5, 95% CI: 1.1 to 6.2, p = 0.038, respectively). In the NSVT subset, the presence of fibrosis was the only independent predictor of the endpoint (HR: 4.2, 95% CI: 1.7 to 10.1, p = 0.006).
  
  
  CONCLUSIONS
  LGE-CMR-detected fibrosis is an independent predictor of adverse outcomes in patients with ventricular arrhythmia and may have an important role in risk stratification. (The Prognostic Significance of Fibrosis Detection in Ischemic and Non-Ischemic Cardiomyopathy; NCT00930735).
authors: Cardiovascular Medicine Research Unit, School of Medicine and Dentistry, University of Aberdeen, Aberdeen, United Kingdom. dana.dawson@abdn.ac.uk
authors: Dana K
authors: DK
authors: Dawson
authors: Karin
authors: K
authors: Hawlisch
authors: Gordon
authors: G
authors: Prescott
authors: Isabelle
authors: I
authors: Roussin
authors: Elisa
authors: E
authors: Di Pietro
authors: Monica
authors: M
authors: Deac
authors: Joyce
authors: J
authors: Wong
authors: Michael P
authors: MP
authors: Frenneaux
authors: Dudley J
authors: DJ
authors: Pennell
authors: Sanjay K
authors: SK
authors: Prasad
mesh_terms: D000328:Adult; D000368:Aged; D016009:Chi-Square Distribution; D003287:Contrast Media; D016757:Death, Sudden, Cardiac / Q000209:etiology; D017147:Defibrillators, Implantable; D018572:Disease-Free Survival; D004554:Electric Countershock / Q000295:instrumentation; D005260:Female; D005355:Fibrosis; D006801:Humans; D053208:Kaplan-Meier Estimate; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009206:Myocardium / Q000473:pathology*; D009942:Organometallic Compounds; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013318:Stroke Volume; D013599:Systole; D017180:Tachycardia, Ventricular / Q000150:complications / Q000175:diagnosis* / Q000401:mortality / Q000473:pathology / Q000503:physiopathology / Q000628:therapy; D013997:Time Factors; D016277:Ventricular Function, Left
chemical_list: D003287:Contrast Media; D009942:Organometallic Compounds; C090600:gadobutrol