Korean J Radiol.  2015 Aug;16(4):683-695. 10.3348/kjr.2015.16.4.683.

Cardiac Magnetic Resonance Scar Imaging for Sudden Cardiac Death Risk Stratification in Patients with Non-Ischemic Cardiomyopathy

• Kim EK
• Chattranukulchai P
• Klem I

• KMID: 2155542
• DOI: http://doi.org/10.3348/kjr.2015.16.4.683

Abstract

In patients with non-ischemic cardiomyopathy (NICM), risk stratification for sudden cardiac death (SCD) and selection of patients who would benefit from prophylactic implantable cardioverter-defibrillators remains challenging. We aim to discuss the evidence of cardiac magnetic resonance (CMR)-derived myocardial scar for the prediction of adverse cardiovascular outcomes in NICM. From the 15 studies analyzed, with a total of 2747 patients, the average prevalence of myocardial scar was 41%. In patients with myocardial scar, the risk for adverse cardiac events was more than 3-fold higher, and risk for arrhythmic events 5-fold higher, as compared to patients without scar. Based on the available observational, single center studies, CMR scar assessment may be a promising new tool for SCD risk stratification, which merits further investigation.

Keyword

Non-ischemic cardiomyopathy; Sudden cardiac death; Cardiac magnetic resonance

MeSH Terms

Arrhythmias, Cardiac/*diagnosis
Cardiomyopathies/*diagnosis
Cicatrix/*diagnosis
Death, Sudden, Cardiac
Defibrillators, Implantable
Female
Humans
Magnetic Resonance Imaging, Cine/*methods
Myocardium/pathology
Risk Assessment
Risk Factors

Figure

• 

  Fig. 1 Different delayed enhancement patterns in non-ischemic cardiomyopathy. Patient 1. 48-year-old female with history of dilated cardiomyopathy. Delayed enhancement images demonstrate intramural contrast enhancement in septum (midwall striae, arrowheads). A. Mid-ventricular short-axis view. B. 4-chamber-view. Patient 2. 50-year-old male with remote history of biopsy-proven viral myocarditis presented with left ventricular dysfunction. Delayed enhancement images demonstrate epicardial hyperenhancement localized at basal inferolateral wall (arrowheads). C. Basal-short axis view. D. 3-chamber-view. Patient 3. 68-year-old male presented with progressive left ventricular dysfunction found to have insignificant coronary stenosis (25% middle left anterior descending artery lesion) on invasive coronary angiography. Delayed enhancement images demonstrate subendocardial hyperenhancement with 75% transmurality (arrowheads) involving inferior and inferolateral walls from middle ventricular level extending through apex consistent with ischemic injury. E. Mid-ventricular short axis view. F. 3-chamber-view.

• 

  Fig. 2 Individual and pooled hazard ratios from univariate Cox proportional hazards analysis for risk of major cardiovascular events. Forest plot comparing prognosis of NICM patients with and without scar, detected by delayed-enhancement CMR. CI = confidence interval, MACE = major adverse cardiovascular event, NICM = non-ischemic cardiomyopathy

• 

  Fig. 3 Individual and pooled hazard ratios from univariate Cox proportional hazards analysis for risk of all-cause mortality. Forest plot comparing prognosis of NICM patients with and without scar, detected by delayed-enhancement MRI. CI = confidence interval, NICM = non-ischemic cardiomyopathy, SE = standard error

• 

  Fig. 4 Individual and pooled hazard ratios from univariate Cox proportional hazards analysis for risk of arrhythmic events. Forest plot comparing prognosis of NICM patients with and without scar, detected by delayed-enhancement MRI. CI = confidence interval, NICM = non-ischemic cardiomyopathy, SE = standard error

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