The prognostic role of late gadolinium enhancement on cardiac magnetic
resonance in patients with nonischemic cardiomyopathy and reduced
ejection fraction, implanted with cardioverter defibrillators for
primary prevention. A systematic review and meta-analysis
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Abstract
Background Previous studies suggest that late gadolinium enhancement
(LGE) on cardiac magnetic resonance (CMR) is associated with arrhythmic
events in patients with nonischemic cardiomyopathy (NICM), while others
have questioned the role of left ventricular ejection fraction (LVEF) as
a sole predictor of future events. Objectives To evaluate the role of
LGE on CMR in identifying patients with NICM and reduced LVEF for whom a
benefit from defibrillator implantation for primary prevention is not
anticipated, thus they are mainly exposed to potential risks. Methods
Major electronic databases were searched for studies reporting the
incidence of appropriate device therapy (ADT), sudden cardiac death
(SCD), and cardiac death based on the presence of LGE on CMR, among
patients with NICM and reduced LVEF, implanted with a cardioverter
defibrillator for primary prevention. Results Eleven studies (1652
patients, 947 with LGE) were included in the final analysis. LGE
presence was strongly associated with ADT (logOR: 1.95, 95%CI:
1.21-2.69) and cardiac death (logOR: 0.91, 95%CI: 0.14-1.68), but not
with SCD (logOR: 0.26, 95%CI: -1.09-1.6). Diagnostic accuracy analysis
demonstrated that contrast enhancement is a sensitive marker of future
ADT and cardiac death (93%, 95%CI: 85.8-96.7%; 82.9%, 95%CI:
70.6-90.7%; respectively), with moderate specificity ( 44%, 95%CI:
27.2-62.6%; 37.7%, 95%CI: 23.4-54.6%; respectively). Conclusion LGE
is a highly sensitive predictor of ADT and cardiac death in NICM
patients implanted with a defibrillator for primary prevention. However,
due to moderate specificity, derivation of a cutoff with adequate
predictive values and probably a multifactorial approach are needed to
improve discrimination of patients who will not benefit from ICDs