Incidence of ischemic late gadolinium enhancement in patients with dilated cardiomyopathy

By Samar Mahmoud, MS
Published January 28, 2022

Key Takeaways

  • This study found that the ischemic pattern of late gadolinium enhancement (LGE) was common among dilated cardiomyopathy (DCM) patients without coronary artery disease (CAD). In this population, ischemic LGE was associated with adverse long-term outcomes.

While LGE patterns in DCM patients typically include intramyocardial and subepicardial distributions, the ischemic pattern of LGE has also been reported in DCM patients without CAD.

Why This Study Matters

The incidence and predictive value of the ischemic LGE pattern in DCM has not been explored. This study sought to evaluate the prevalence of ischemic LGE as well as assess correlations with long-term outcomes.

Study Design

The study included 611 DCM patients who underwent cardiac magnetic resonance imaging. 

The primary outcome of the study was a composite endpoint of all-cause mortality, major ventricular arrhythmias (MVAs), and heart transplantation (HTx) or ventricular assist device (VAD) implantation.  

Secondary outcomes included a composite of sudden cardiac death or MVAs as well as a composite of death for refractory heart failure, HTx, or VAD implantation. 

Results and Conclusions

Ischemic LGE, typically inferior/inferolateral/anterolateral, was found in 7% of patients without significant CAD or history of myocardial infarction. 

Patients with ischemic LGE were more likely to have hypertension or atrial fibrillation or flutter in comparison to patients with non-ischemic LGE. 

Ischemic LGE was associated with greater risk of the primary endpoint at 5 years in comparison to non-ischemic LGE. 

After adjustment for multiple variables, ischemic LGE remained a predictor of the primary outcome of the study. 

Related Research

Consider these findings from similar research studies:

  • LGE at the right ventricular insertion point was not associated with an increased risk of adverse cardiac events and showed better outcomes than LGE located at the left ventricle (Source). 

  • In patients with DCM, the presence of LGE was a strong predictor of high-risk patients (Source).

Original Source 

De Angelis G, De Luca A, Merlo M, et al. Prevalence and prognostic significance of ischemic late gadolinium enhancement pattern in non-ischemic dilated cardiomyopathy. American Heart Journal. Published online January 2022:S0002870322000060.

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