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Towards cardiac MRI based risk stratification in idiopathic dilated cardiomyopathy

Pamela Frances Brown1, Chris Miller1, Andrea Di Marco2

  • 1Cardiac MRI Department, North West Heart Centre, Manchester University Foundation Trust-Wythenshawe Site, Manchester, UK.

Heart (British Cardiac Society)
|November 1, 2018
PubMed

Insights

Sudden cardiac death (SCD) risk in dilated cardiomyopathy (DCM) needs better prediction. Cardiac MRI offers advanced imaging beyond ejection fraction to identify patients who would benefit most from an implantable cardiac defibrillator (ICD).

Area of Science:

  • Cardiology
  • Medical Imaging
  • Biomarkers

Background:

  • Sudden cardiac death (SCD) risk persists in dilated cardiomyopathy (DCM) patients, even with current implantable cardiac defibrillator (ICD) selection criteria.
  • Current guidelines for ICD implantation in DCM, based on ejection fraction (EF) <35%, are insufficient as most SCD events occur in patients with EF >35%.

Purpose of the Study:

  • To evaluate the role of Cardiac Magnetic Resonance (CMR) imaging in improving risk stratification for SCD in DCM patients.
  • To explore advanced CMR techniques beyond EF for identifying fibrosis and predicting outcomes.

Main Methods:

  • Utilizing Cardiac Magnetic Resonance (CMR) for ejection fraction (EF) calculation and detailed myocardial tissue characterization.
  • Assessing late gadolinium enhancement (LGE) for focal fibrosis detection.
  • Investigating T1 mapping and extracellular volume (ECV) calculation for diffuse myocardial fibrosis assessment.

Main Results:

  • Late gadolinium enhancement (LGE) identifies mid-wall fibrosis in approximately 30% of DCM patients, strongly associated with increased SCD risk.
  • Elevated ECV and native T1 values are linked to adverse outcomes, though their direct relationship with SCD requires further study.
  • CMR offers incremental value over EF for risk stratification in DCM.

Conclusions:

  • Standard EF criteria are inadequate for selecting DCM patients for primary prevention ICDs.
  • CMR, through techniques like LGE, T1 mapping, and ECV, provides superior risk stratification for SCD in DCM.
  • Further research is needed, but CMR tools can optimize patient selection, improve outcomes, and enhance resource utilization in DCM management.

Keywords:
cardiac arrestcardiac magnetic resonance (CMR) imagingheart failure with reduced ejection fractionidiopathic dilated cardiomyopathyimplanted cardiac defibrillators

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