Septal LGE predicts major ventricular arrhythmia, cardiac death in cardiomyopathy

Late gadolinium enhancement (LGE) with septal location is significantly associated with major arrhythmic events among patients with dilated cardiomyopathy (DCM) and nondilated left ventricular (LV) cardiomyopathy (NDLVC), suggests a recent study.

Other predictors of ventricular arrhythmias include LV dilatation, age, advanced disease, and frequent and repetitive ventricular activity.

A team of investigators retrospectively analysed 462 patients with cardiac magnetic resonance data from four different referral centres. Of these, 227 had DCM and 235 NDLVC. The primary endpoint was a composite of sudden cardiac death or major ventricular arrhythmias.

NDLVC, compared with DCM, showed a higher prevalence of pathogenic or likely pathogenic variants of arrhythmogenic genes (40 percent vs 23 percent; p<0.001), higher LV systolic function (LV ejection fraction: 51 percent vs 36 percent; p<0.001), and greater prevalence of free-wall LGE (27 percent vs 14 percent; p<0.0001).

On the other hand, DCM had a higher prevalence of pathogenic or likely pathogenic variants of nonarrhythmogenic genes (23 percent vs 12 percent; p=0.002) and septal LGE (45 percent vs 32 percent; p=0.004). Of the patients, 98 (21 percent) met the primary endpoint during a median follow-up of 81 months.

LGE with septal location (hazard ratio, 1.929, 95 percent confidence interval, 1.033‒3.601; p=0.039) independently correlated with a higher risk of sudden cardiac death or major ventricular arrhythmias, as did LV dilatation, older age, advanced New York Heart Association (NYHA) functional class, frequent ventricular ectopic activity, and nonsustained ventricular tachycardia.