title: Late Gadolinium Enhancement in Patients with Nonischemic Dilated Cardiomyopathy.
abstract: One-third of all patients with heart failure have nonischemic dilated cardiomyopathy (NIDM). Five-year mortality from NIDM is as high as 20% with sudden cardiac death (SCD) as the cause in 30% of the deaths. Currently, the left ventricular ejection fraction (LVEF) is used as the main criteria to risk stratify patients requiring an implantable cardioverter defibrillator (ICD) to prevent SCD. However, LVEF does not necessarily reflect myocardial propensity for electrical instability leading to ventricular tachycardia (VT) or ventricular fibrillation (VF). Due to the differential risk in various subgroups of patients for arrhythmic death, it is important to identify appropriate patients for ICD implantation so that we can optimize healthcare resources and avoid the complications of ICDs in individuals who are unlikely to benefit. We performed a systematic search and review of clinical trials of NIDM and the use of ICDs and cardiac magnetic resonance imaging with late gadolinium enhancement (LGE) for risk stratification. LGE identifies patients with NIDM who are at high risk for SCD and enables optimized patient selection for ICD placement, while the absence of LGE may reduce the need for ICD implantation in patients with NIDM who are at low risk for future VF/VT or SCD.
authors.affiliation: Division of Cardiology, Hartford Hospital, Hartford, Connecticut.
authors.forename: Sarfaraz
authors.initials: S
authors.lastname: Memon
authors.affiliation: Division of Cardiology, Brown University, Providence, Rhode Island.
authors.forename: Harsha V
authors.initials: HV
authors.lastname: Ganga
authors.affiliation: Division of Cardiology, Hartford Hospital, Hartford, Connecticut.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Kluger
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002311:Cardiomyopathy, Dilated / Q000000981:diagnostic imaging* / Q000401:mortality*; D015897:Comorbidity; D003287:Contrast Media; D016757:Death, Sudden, Cardiac / Q000453:epidemiology*; D005682:Gadolinium; D006333:Heart Failure; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods* / Q000706:statistics & numerical data; D008875:Middle Aged; D015995:Prevalence; D015203:Reproducibility of Results; D012307:Risk Factors; D012680:Sensitivity and Specificity; D015996:Survival Rate
chemical_list: D003287:Contrast Media; D005682:Gadolinium
keywords: cardiomyopathy; late gadolinium; sudden death; ventricular tachycardia