Catheter Ablation -> Ventricular Arrhythmias -> Mapping & Imaging D-PO06 - Poster Session VI (ID 26) Poster

D-PO06-092 - Septal Midwall Late Gadolinium Enhancement Predictor Of Adverse Events In Both Ischemic And Nonischemic Dilated Cardiomyopathy (ID 659)


Background: Septal midwall LGE is typically described in nonischemic dilated cardiomyopathy (DCM) and is associated with adverse events. It is also seen in ischemic cardiomyopathy (ICM), although its clinical implications remain unknown.
Objective: To describe the characteristics of septal midwall LGE and study its predictive value on all-cause mortality and ventricular arrhythmias (VAs) in both DCM and ICM.
Methods: A retrospective, multicenter, observational study, including patients with LV dysfunction (LVEF <50%). Septal midwall LGE was defined as midmyocardial stripe or patchy enhancement. Endpoints were all-cause mortality and VAs, including sudden cardiac arrest, sustained VT or appropriate ICD-therapy.
Results: We included 1084 patients (53% ICM). Septal midwall LGE was found in 34% of DCM-patients and in 10% of ICM-patients (p<0.001). LV volumes were larger (LVEDVi 130mL/m2 vs. 108mL/m2, p<0.001) and LVEF was lower (28% vs. 38%, p<0.001) with septal midwall LGE present. During a follow-up of 2.2±1.2 years, 123 patients died (78 with ICM vs. 45 with DCM (p=0.02)). In DCM-patients, septal midwall LGE presence was associated with increased mortality, while this was not seen in ICM (Figure A-C). Patients with septal midwall LGE had increased VAs at follow-up, in both DCM and ICM (Figure D-F).
Conclusion: Septal midwall LGE, primarily seen in DCM, was also present in 10% of ICM-patients and was associated with increased LV volumes and lower LVEF, suggesting an advanced stage of myocardial remodeling. Septal midwall LGE significantly increased VAs, irrespective of etiology. In DCM, septal midwall LGE was also associated with increased mortality.