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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.

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Acknowledgements

IA, CK, and GG were involved in study conception and design. MK and EL were involved in searched databases and extracted data of interest. IA, GG, CK, SD, and NA were involved in data analysis and interpretation. IA, MK, EL, NTP, and NS drafted the manuscript. All authors were involved in manuscripts’ critical revision.

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Authors and Affiliations

  1. Cardiology Department, Athens General Hospital “G. Gennimatas,”, 154 Mesogion Avenue, 11527, Athens, Greece

    Ioannis Anagnostopoulos, Maria Kousta, Charalampos Kossyvakis, Eleni Lakka, Nikolaos Taxiarchis Paraskevaidis & Georgios Giannopoulos

  2. Department of Cardiothoracic Surgery, Evangelismos Hospital, Athens, Greece

    Nikolaos Schizas

  3. 2nd Department of Cardiology, Athens Euroclinic, Athens, Greece

    Nikolaos Alexopoulos

  4. 2nd Department of Cardiology, National and Kapodistrian University of Athens, Athens, Greece

    Spyridon Deftereos

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  1. Ioannis Anagnostopoulos
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Contributions

IA, CK, and GG conceived the concept of the study. MK and EL were involved in studies screening and data extraction. IA and GG performed the statistical analysis. IA, MK, NTP, and NS drafted the manuscript. CK, NA, SD, and GG critically reviewed the manuscript.

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Correspondence to Ioannis Anagnostopoulos.

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Anagnostopoulos, I., Kousta, M., Kossyvakis, C. et al. 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. J Interv Card Electrophysiol 63, 523–530 (2022). https://doi.org/10.1007/s10840-021-01027-6

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