Share this content in WeChat
Clinical Article
The diagnostic and prognositic value of cardiac magnetic resonance for evaluating dilated cardiomyopathy with ventricular arrhythmia
KAN Ao  LI Shuhao  FANG Qimin  HUANG Kaiyao  GONG Lianggeng 

Cite this article as: KAN A, LI S H, FANG Q M, et al. The diagnostic and prognositic value of cardiac magnetic resonance for evaluating dilated cardiomyopathy with ventricular arrhythmia[J]. Chin J Magn Reson Imaging, 2023, 14(5): 116-122. DOI:10.12015/issn.1674-8034.2023.05.021.

[Abstract] Objective To qualitatively and quantitatively evaluate the changes in myocardial motion and tissue characterizations in non-ischemic dilated cardiomyopathy (NIDCM) patients with ventricular arrhythmias (VA) by cardiac magnetic resonance feature tracking (CMR-FT) and late gadolinium enhancement (LGE).Materials and Methods Seventy-three NIDCM patients were retrospectively collected and followed up. The patients were divided into VA+ group (34 cases) and VA- group (39 cases) according to the 24-hour dynamic ECG. The left ventricular function parameters, global strain parameters and LGE characteristics were compared between the two groups. The risk factors of VA were estimated by performing multivariate logistic regression analysis. Survival estimates of the two groups were calculated and determined by Kaplan-Meier curves with the log-rank test.Results The global longitudinal peak strain (GLPS) in the VA+ group was significantly lower than that in VA- group (P=0.004). The subepicardial LGE pattern was more likely to appear in VA+ group (P=0.001). The outcome was poorer in the VA+ group than in the VA- group (P=0.036). Moreover, the subepicardial pattern of the LGE was a risk factor of VA.Conclusions Cardiac magnetic resonance can accurately assess the changes of heart structure, function, and myocardial tissue in NIDCM patients with VA, and provide forceful imaging basis for the poor outcome of NIDCM patients.
[Keywords] non-ischemic dilated cardiomyopathy;ventricular arrhythmia;cardiac magnetic resonance;feature tracking;late gadolinium enhancement;magnetic resonance imaging

KAN Ao1   LI Shuhao1   FANG Qimin1   HUANG Kaiyao2   GONG Lianggeng1*  

1 The Medical Imaging Center, the Second Affiliated Hospital of Nanchang University, Nanchang 330000, China

2 The Second Clinical Medical School of Nanchang University, Nanchang 330031, China

Corresponding author: Gong LG, E-mail:

Conflicts of interest   None.

ACKNOWLEDGMENTS National Natural Science Foundation of China (No. 82260342, 81860316); Major Project of Education Department of Jiangxi Province (No. GJJ210113).
Received  2022-11-28
Accepted  2023-04-23
DOI: 10.12015/issn.1674-8034.2023.05.021
Cite this article as: KAN A, LI S H, FANG Q M, et al. The diagnostic and prognositic value of cardiac magnetic resonance for evaluating dilated cardiomyopathy with ventricular arrhythmia[J]. Chin J Magn Reson Imaging, 2023, 14(5): 116-122. DOI:10.12015/issn.1674-8034.2023.05.021.

WEINTRAUB R G, SEMSARIAN C, MACDONALD P. Dilated cardiomyopathy[J]. Lancet, 2017, 390(10092): 400-414. DOI: 10.1016/S0140-6736(16)31713-5">10.1016/S0140-6736(16)31713-5">10.1016/S0140-6736(16)31713-5.
DI MARCO A, BROWN P F, BRADLEY J, et al. Improved risk stratification for ventricular arrhythmias and sudden death in patients with nonischemic dilated cardiomyopathy[J]. J Am Coll Cardiol, 2021, 77(23): 2890-2905. DOI: 10.1016/j.jacc.2021.04.030">10.1016/j.jacc.2021.04.030">10.1016/j.jacc.2021.04.030.
HALLIDAY B P, CLELAND J G F, GOLDBERGER J J, et al. Personalizing risk stratification for sudden death in dilated cardiomyopathy: the past, present, and future[J]. Circulation, 2017, 136(2): 215-231. DOI: 10.1161/CIRCULATIONAHA.116.027134">10.1161/CIRCULATIONAHA.116.027134">10.1161/CIRCULATIONAHA.116.027134.
AKHTAR M, ELLIOTT P M. Risk stratification for sudden cardiac death in non-ischaemic dilated cardiomyopathy[J/OL]. Curr Cardiol Rep, 2019, 21(12): 155 [2022-12-03]. DOI: 10.1007/s11886-019-1236-3">10.1007/s11886-019-1236-3">10.1007/s11886-019-1236-3.
CANNATÀ A, DE ANGELIS G, BOSCUTTI A, et al. Arrhythmic risk stratification in non-ischaemic dilated cardiomyopathy beyond ejection fraction[J]. Heart, 2020, 106(9): 656-664. DOI: 10.1136/heartjnl-2019-315942">10.1136/heartjnl-2019-315942">10.1136/heartjnl-2019-315942.
DI MARCO A, ANGUERA I, SCHMITT M, et al. Late gadolinium enhancement and the risk for ventricular arrhythmias or sudden death in dilated cardiomyopathy: systematic review and meta-analysis[J]. JACC Heart Fail, 2017, 5(1): 28-38. DOI: 10.1016/j.jchf.2016.09.017">10.1016/j.jchf.2016.09.017">10.1016/j.jchf.2016.09.017.
NELSON T, GARG P, CLAYTON R H, et al. The role of cardiac MRI in the management of ventricular arrhythmias in ischaemic and non-ischaemic dilated cardiomyopathy[J]. Arrhythm Electrophysiol Rev, 2019, 8(3): 191-201. DOI: 10.15420/aer.2019.5.1">10.15420/aer.2019.5.1">10.15420/aer.2019.5.1.
KEIL L, CHEVALIER C, KIRCHHOF P, et al. CMR-based risk stratification of sudden cardiac death and use of implantable cardioverter-defibrillator in non-ischemic cardiomyopathy[J/OL]. Int J Mol Sci, 2021, 22(13): 7115 [2022-12-03]. DOI: 10.3390/ijms22137115">10.3390/ijms22137115">10.3390/ijms22137115.
DONAL E, DELGADO V, BUCCIARELLI-DUCCI C, et al. Multimodality imaging in the diagnosis, risk stratification, and management of patients with dilated cardiomyopathies: an expert consensus document from the European Association of Cardiovascular Imaging[J]. Eur Heart J Cardiovasc Imaging, 2019, 20(10): 1075-1093. DOI: 10.1093/ehjci/jez178">10.1093/ehjci/jez178">10.1093/ehjci/jez178.
Cardiovascular Diseases Branch of Chinese Medical Association, Chinese Myocarditis and Cardiomyopathy Collaborative Group. China guidelines for diagnosis and treatment of dilated cardiomyopathy[J]. J Clin Cardiol, 2018, 34(5): 421-434. DOI: 10.13201/j.issn.1001-1439.2018.05.001">10.13201/j.issn.1001-1439.2018.05.001">10.13201/j.issn.1001-1439.2018.05.001.
Electrophysiology and Pacing Branch of Chinese Medical Association, Professional Committee of Cardiology of the Chinese Medical Doctor Association. The interpretation of 2020 Chinese Society of Pacing and Electrophysiology (CSPE)/Chinese Society of Arrhythmias (CSA) expert consensus statement on ventricular arrhythmias[J]. Chin J Cardiac Arrhythm, 2020, 24(4): 348-350. DOI: 10.3760/">10.3760/">10.3760/
GULATI A, JABBOUR A, ISMAIL T F, et al. Association of fibrosis with mortality and sudden cardiac death in patients with nonischemic dilated cardiomyopathy[J]. JAMA, 2013, 309(9): 896-908. DOI: 10.1001/jama.2013.1363">10.1001/jama.2013.1363">10.1001/jama.2013.1363.
HALLIDAY B P, BAKSI A J, GULATI A, et al. Outcome in dilated cardiomyopathy related to the extent, location, and pattern of late gadolinium enhancement[J]. JACC Cardiovasc Imaging, 2019, 12(8Pt 2): 1645-1655. DOI: 10.1016/j.jcmg.2018.07.015">10.1016/j.jcmg.2018.07.015">10.1016/j.jcmg.2018.07.015.
LI R, CUI C, LAN T, et al. Late gadolinium enhancement distribution pattern of left ventricular wall in patients with dilated cardiomyopathy: a preliminary study[J]. Chin J Cardiol, 2020, 48(11): 922-929. DOI: 10.3760/cma.j.cn112148-20200813-00638">10.3760/cma.j.cn112148-20200813-00638">10.3760/cma.j.cn112148-20200813-00638.
KØBER L, THUNE J J, NIELSEN J C, et al. Defibrillator implantation in patients with nonischemic systolic heart failure[J]. N Engl J Med, 2016, 375(13): 1221-1230. DOI: 10.1056/NEJMoa1608029">10.1056/NEJMoa1608029">10.1056/NEJMoa1608029.
THEUNS D A, VERSTRAELEN T E, VAN DER LINGEN A C J, et al. Implantable defibrillator therapy and mortality in patients with non-ischaemic dilated cardiomyopathy: an updated meta-analysis and effect on Dutch clinical practice by the Task Force of the Dutch Society of Cardiology[J]. Neth Heart J, 2023, 31(3): 89-99. DOI: 10.1007/s12471-022-01718-3">10.1007/s12471-022-01718-3">10.1007/s12471-022-01718-3.
ALBA A C, FOROUTAN F, DUERO POSADA J, et al. Implantable cardiac defibrillator and mortality in non-ischaemic cardiomyopathy: an updated meta-analysis[J]. Heart, 2018, 104(3): 230-236. DOI: 10.1136/heartjnl-2017-311430">10.1136/heartjnl-2017-311430">10.1136/heartjnl-2017-311430.
MARROW B A, COOK S A, PRASAD S K, et al. Emerging techniques for risk stratification in nonischemic dilated cardiomyopathy: JACC review topic of the week[J]. J Am Coll Cardiol, 2020, 75(10): 1196-1207. DOI: 10.1016/j.jacc.2019.12.058">10.1016/j.jacc.2019.12.058">10.1016/j.jacc.2019.12.058.
LI Y J, LIU X M, XU Y W, et al. The prognostic value of left ventricular mechanical dyssynchrony derived from cardiac MRI in patients with idiopathic dilated cardiomyopathy[J/OL]. Radiol Cardiothorac Imaging, 2021, 3(4): e200536 [2022-12-03]. DOI: 10.1148/ryct.2021200536">10.1148/ryct.2021200536">10.1148/ryct.2021200536.
ZHOU Y L, HE Z, LIAO S G, et al. Prognostic value of integrative analysis of electrical and mechanical dyssynchrony in patients with acute heart failure[J]. J Nucl Cardiol, 2021, 28(1): 140-149. DOI: 10.1007/s12350-020-02429-1">10.1007/s12350-020-02429-1">10.1007/s12350-020-02429-1.
SHU S L, WANG J, WANG C, et al. Prognostic value of feature-tracking circumferential strain in dilated cardiomyopathy patients with severely reduced ejection fraction incremental to late gadolinium enhancement[J]. Curr Med Sci, 2021, 41(1): 158-166. DOI: 10.1007/s11596-021-2331-4">10.1007/s11596-021-2331-4">10.1007/s11596-021-2331-4.
LI S, WANG Y N, YANG W J, et al. Cardiac MRI risk stratification for dilated cardiomyopathy with left ventricular ejection fraction of 35% or higher[J/OL]. Radiology, 2023, 306(3): e213059 [2023-04-13]. DOI: 10.1148/radiol.213059">10.1148/radiol.213059">10.1148/radiol.213059.
SONG L S, ZHAO X Y, LV W L, et al. Preliminary study on the diagnostic value of cardiac magnetic resonance feature tracking for malignant ventricular arrhythmias in non-ischemic dilated cardiomyopathy[J/OL]. Ann Transl Med, 2022, 10(4): 215 [2022-12-03]. DOI: 10.21037/atm-22-660">10.21037/atm-22-660">10.21037/atm-22-660.
PILICHOU K, MANCINI M, RIGATO I, et al. Nonischemic left ventricular scar: sporadic or familial? Screen the genes, scan the mutation carriers[J/OL]. Circulation, 2014, 130(21): e180-e182 [2022-12-03]. DOI: 10.1161/CIRCULATIONAHA.114.012515">10.1161/CIRCULATIONAHA.114.012515">10.1161/CIRCULATIONAHA.114.012515.
BALABAN G, HALLIDAY B P, BAI W J, et al. Scar shape analysis and simulated electrical instabilities in a non-ischemic dilated cardiomyopathy patient cohort[J/OL]. PLoS Comput Biol, 2019, 15(10): e1007421 [2022-12-03]. DOI: 10.1371/journal.pcbi.1007421">10.1371/journal.pcbi.1007421">10.1371/journal.pcbi.1007421.
SHIN D G, LEE H J, PARK J, et al. Pattern of late gadolinium enhancement predicts arrhythmic events in patients with non-ischemic cardiomyopathy[J]. Int J Cardiol, 2016, 222: 9-15. DOI: 10.1016/j.ijcard.2016.07.122">10.1016/j.ijcard.2016.07.122">10.1016/j.ijcard.2016.07.122.
GLASHAN C A, ANDROULAKIS A F A, TAO Q, et al. Whole human heart histology to validate electroanatomical voltage mapping in patients with non-ischaemic cardiomyopathy and ventricular tachycardia[J]. Eur Heart J, 2018, 39(31): 2867-2875. DOI: 10.1093/eurheartj/ehy168">10.1093/eurheartj/ehy168">10.1093/eurheartj/ehy168.
MUSER D, LIANG J J, PATHAK R K, et al. Long-term outcomes of catheter ablation of electrical storm in nonischemic dilated cardiomyopathy compared with ischemic cardiomyopathy[J]. JACC Clin Electrophysiol, 2017, 3(7): 767-778. DOI: 10.1016/j.jacep.2017.01.020">10.1016/j.jacep.2017.01.020">10.1016/j.jacep.2017.01.020.
PURMAH Y, CORNHILL A, LEI L Y, et al. Mid-wall striae fibrosis predicts heart failure admission, composite heart failure events, and life-threatening arrhythmias in dilated cardiomyopathy[J/OL]. Sci Rep, 2022, 12(1): 1739 [2022-12-03]. DOI: 10.1038/s41598-022-05790-y">10.1038/s41598-022-05790-y">10.1038/s41598-022-05790-y.
VOSKOBOINIK A, WONG M C G, ELLIOTT J K, et al. Absence of late gadolinium enhancement on cardiac magnetic resonance imaging in ventricular fibrillation and nonischemic cardiomyopathy[J]. Pacing Clin Electrophysiol, 2018, 41(9): 1109-1115. DOI: 10.1111/pace.13426">10.1111/pace.13426">10.1111/pace.13426.
CENTURIÓN O A, ALDERETE J F, TORALES J M, et al. Myocardial fibrosis as a pathway of prediction of ventricular arrhythmias and sudden cardiac death in patients with nonischemic dilated cardiomyopathy[J]. Crit Pathw Cardiol, 2019, 18(2): 89-97. DOI: 10.1097/HPC.0000000000000171">10.1097/HPC.0000000000000171">10.1097/HPC.0000000000000171.

PREV Diagnostic value of DCE-MRI combined with DKI in predicting the triple negative breast cancer
NEXT Multi-center study on the prognostic value of cardiac magnetic resonance feature tracking technique for MACE after percutaneous coronary intervention in patients with acute myocardial infarction during hospitalization

Tel & Fax: +8610-67113815    E-mail: