title: Pattern of late gadolinium enhancement predicts arrhythmic events in patients with non-ischemic cardiomyopathy.
abstract: 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.
authors.affiliation: Division of Cardiology, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Dong Geum
authors.initials: DG
authors.lastname: Shin
authors.affiliation: Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Hye-Jeong
authors.initials: HJ
authors.lastname: Lee
authors.affiliation: Department of Cardiology, School of Medicine, Ewha Womans University College, Seoul, Republic of Korea.
authors.forename: Junbeom
authors.initials: J
authors.lastname: Park
authors.affiliation: Division of Cardiology, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Jae-Sun
authors.initials: JS
authors.lastname: Uhm
authors.affiliation: Division of Cardiology, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Hui-Nam
authors.initials: HN
authors.lastname: Pak
authors.affiliation: Division of Cardiology, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Moon-Hyoung
authors.initials: MH
authors.lastname: Lee
authors.affiliation: Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Republic of Korea. Electronic address: dryj@yuhs.ac.
authors.forename: Young Jin
authors.initials: YJ
authors.lastname: Kim
authors.affiliation: Division of Cardiology, Yonsei University College of Medicine, Seoul, Republic of Korea. Electronic address: cby6908@yuhs.ac.
authors.forename: Boyoung
authors.initials: B
authors.lastname: Joung
mesh_terms: D000328:Adult; D000368:Aged; D001145:Arrhythmias, Cardiac / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality / Q000628:therapy; D009202:Cardiomyopathies / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology; D016757:Death, Sudden, Cardiac / Q000453:epidemiology / Q000517:prevention & control; D005260:Female; D005682:Gadolinium / Q000494:pharmacology; D006352:Heart Ventricles / Q000187:drug effects / Q000503:physiopathology; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D011868:Radioisotopes; D056910:Republic of Korea / Q000453:epidemiology; D018570:Risk Assessment / Q000379:methods
chemical_list: D011868:Radioisotopes; D005682:Gadolinium
keywords: Arrhythmic events; Cardiac MRI; Late gadolinium enhancement; Nonischemic cardiomyopathy; Predictor