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Ringlike late gadolinium enhancement provides incremental prognostic value in non-classical arrhythmogenic

Yuelong Yang1, Xiaoyu Wei2, Guanyu Lu3

  • 1Department of Radiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, China.

Journal of Cardiovascular Magnetic Resonance : Official Journal of the Society for Cardiovascular Magnetic Resonance
|November 30, 2023
PubMed

Insights

Ringlike late gadolinium enhancement (LGE) in non-classical arrhythmogenic cardiomyopathy (ACM) significantly improves prediction of ventricular arrhythmia (VA). This finding enhances the 2019 ARVC risk model for better patient outcomes.

Area of Science:

  • Cardiology
  • Medical Imaging
  • Genetics

Background:

  • The 2019 arrhythmogenic right ventricular cardiomyopathy (ARVC) risk model has limitations in predicting ventricular arrhythmia (VA) in non-classical arrhythmogenic cardiomyopathy (ACM).
  • The prognostic significance of ringlike late gadolinium enhancement (LGE) in the left ventricle of non-classical ACM patients is currently unknown.

Purpose of the Study:

  • To evaluate the added prognostic value of ringlike LGE beyond the 2019 ARVC risk model for predicting sustained VA in non-classical ACM.
  • To determine if ringlike LGE can improve risk stratification in this patient population.

Main Methods:

  • Retrospective analysis of consecutive non-classical ACM patients who underwent cardiac magnetic resonance (CMR) between January 2011 and January 2022.
  • Categorization of LGE patterns (none, non-ringlike, ringlike) and assessment of their association with sustained VA using Cox regression.
  • Calculation of the area under the curve (AUC) to quantify the incremental prognostic value of ringlike LGE.

Main Results:

  • A cohort of 73 patients was analyzed, with 41.1% exhibiting ringlike LGE.
  • Ringlike LGE was independently associated with a higher risk of sustained VA (adjusted hazard ratio: 6.91, P=0.036) after multivariable adjustment.
  • Incorporating ringlike LGE into the 2019 ARVC risk model significantly improved its predictive capability for sustained VA (AUC 0.80 vs. 0.67, P=0.024).

Conclusions:

  • Ringlike LGE demonstrates independent prognostic value in non-classical ACM patients.
  • The presence of ringlike LGE significantly enhances the predictive accuracy of the 2019 ARVC risk model for sustained VA.
  • This finding suggests that ringlike LGE should be considered in the risk stratification of non-classical ACM.
Abstract

Keywords:
Arrhythmogenic cardiomyopathyCardiac magnetic resonanceRinglike late gadolinium enhancementVentricular arrhythmia

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