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Risk Stratification in Nonischemic Dilated Cardiomyopathy Using CMR Imaging: A Systematic Review and Meta-Analysis
Christian Eichhorn1,2,3, David Koeckerling4, Rohin K Reddy5,6
1Division of Acute Medicine, University Hospital Basel, Basel, Switzerland.
JAMA
|September 19, 2024
Summary
Accurate risk stratification for nonischemic dilated cardiomyopathy (NIDCM) is challenging. Cardiac magnetic resonance (CMR) imaging, particularly late gadolinium enhancement (LGE), significantly predicts adverse outcomes, while left ventricular ejection fraction (LVEF) shows limited prognostic value.
Area of Science:
- Cardiology
- Medical Imaging
- Biomedical Engineering
Background:
- Accurate risk stratification in nonischemic dilated cardiomyopathy (NIDCM) is crucial for patient management.
- Cardiac magnetic resonance (CMR) imaging offers detailed insights into myocardial tissue characteristics.
Purpose of the Study:
- To systematically evaluate the association between CMR-derived measurements and clinical outcomes in NIDCM patients.
- To determine the prognostic value of various CMR parameters for adverse events.
Main Methods:
- A comprehensive systematic literature search was conducted across major databases (MEDLINE, Embase, Cochrane, Web of Science) from January 2005 to April 2023.
- Meta-analysis of 103 studies (29,687 patients) using random-effects models to assess associations between CMR parameters (LGE, LVEF, native T1, GLS) and outcomes (mortality, MACE, HF, arrhythmias).
Main Results:
- Presence and extent of late gadolinium enhancement (LGE) were significantly associated with increased all-cause mortality, cardiovascular mortality, arrhythmic events, and heart failure events.
- Left ventricular ejection fraction (LVEF) showed no significant association with mortality or arrhythmic events but was linked to lower risks of heart failure and MACE.
- Higher native T1 relaxation times correlated with increased arrhythmic events and MACE; GLS data were limited for definitive conclusions.
Conclusions:
- Late gadolinium enhancement (LGE) on CMR is a strong predictor of adverse clinical outcomes in NIDCM.
- Left ventricular ejection fraction (LVEF) has limited prognostic utility for mortality and arrhythmias in NIDCM.
- Further research is needed to establish the role of native T1, extracellular volume fraction, and global longitudinal strain in NIDCM risk stratification.
