title: Late Gadolinium Enhancement and the Risk for Ventricular Arrhythmias or Sudden Death in Dilated Cardiomyopathy: Systematic Review and Meta-Analysis.
abstract: 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).
  
  
  
  Risk stratification for SCD in DCM needs to be improved.
  
  
  
  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.
  
  
  
  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).
  
  
  
  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.
authors.affiliation: Arrhythmia Unit, Heart Disease Institute, Bellvitge University Hospital, Barcelona, Spain. Electronic address: ayfanciu@hotmail.com.
authors.forename: Andrea
authors.initials: A
authors.lastname: Di Marco
authors.affiliation: Arrhythmia Unit, Heart Disease Institute, Bellvitge University Hospital, Barcelona, Spain.
authors.forename: Ignasi
authors.initials: I
authors.lastname: Anguera
authors.affiliation: University Hospital of South Manchester, United Kingdom.
authors.forename: Matthias
authors.initials: M
authors.lastname: Schmitt
authors.affiliation: Duke Cardiovascular Magnetic Resonance Center, Duke University Medical Center, Durham, North Carolina.
authors.forename: Igor
authors.initials: I
authors.lastname: Klem
authors.affiliation: Division of Cardiology and Cardiac MR PET CT Program, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Tomas G
authors.initials: TG
authors.lastname: Neilan
authors.affiliation: Stephenson CMR Centre at the Libin Cardiovascular Institute of Alberta, Calgary, Alberta, Canada.
authors.forename: James A
authors.initials: JA
authors.lastname: White
authors.affiliation: Department of Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic.
authors.forename: Marek
authors.initials: M
authors.lastname: Sramko
authors.affiliation: Centre for Cardiovascular Magnetic Resonance, Lausanne University Hospital, Lausanne, Switzerland.
authors.forename: Pier Giorgio
authors.initials: PG
authors.lastname: Masci
authors.affiliation: Fondazione "G. Monasterio," CNR-Regione Toscana, Pisa, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Barison
authors.affiliation: FIDMAG Germanes Hospitalàries Research Foundation, Barcelona, Spain.
authors.forename: Peter
authors.initials: P
authors.lastname: Mckenna
authors.affiliation: BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom.
authors.forename: Ify
authors.initials: I
authors.lastname: Mordi
authors.affiliation: Department of Cardiology, Oslo University Hospital, Oslo, Norway.
authors.forename: Kristina H
authors.initials: KH
authors.lastname: Haugaa
authors.affiliation: Department of Cardiology, The Queen Elizabeth Hospital, Birmingham, United Kingdom.
authors.forename: Francisco
authors.initials: F
authors.lastname: Leyva
authors.affiliation: Antequera Hospital, Malaga, Spain.
authors.forename: Jorge
authors.initials: J
authors.lastname: Rodriguez Capitán
authors.affiliation: Division of Cardiology, Internal Medicine III, Hamamatsu University Hospital, Hamamatsu, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Satoh
authors.affiliation: Department of Cardiovascular Medicine, Kitasato University School of Medicine, Tokyo, Japan.
authors.forename: Takeru
authors.initials: T
authors.lastname: Nabeta
authors.affiliation: Arrhythmia Unit, Heart Disease Institute, Bellvitge University Hospital, Barcelona, Spain.
authors.forename: Paolo Domenico
authors.initials: PD
authors.lastname: Dallaglio
authors.affiliation: University Hospital of South Manchester, United Kingdom.
authors.forename: Niall G
authors.initials: NG
authors.lastname: Campbell
authors.affiliation: Arrhythmia Unit, Heart Disease Institute, Bellvitge University Hospital, Barcelona, Spain.
authors.forename: Xavier
authors.initials: X
authors.lastname: Sabaté
authors.affiliation: Arrhythmia Unit, Heart Disease Institute, Bellvitge University Hospital, Barcelona, Spain.
authors.forename: Ángel
authors.initials: Á
authors.lastname: Cequier
mesh_terms: D001145:Arrhythmias, Cardiac / Q000209:etiology*; D002311:Cardiomyopathy, Dilated / Q000150:complications / Q000000981:diagnostic imaging*; D003287:Contrast Media; D016757:Death, Sudden, Cardiac / Q000209:etiology*; D005682:Gadolinium; D006801:Humans; D008279:Magnetic Resonance Imaging
chemical_list: D003287:Contrast Media; D005682:Gadolinium
keywords: cardiac magnetic resonance; dilated cardiomyopathy; late gadolinium enhancement; sudden death; ventricular arrhythmias