Does having LGE-CMR positivity mean a higher risk of sudden death for cardiomyopathy patients?

Late gadolinium enhancement (LGE) seen on cardiac MRI (CMR) indicates scarring in the heart muscle. For people with cardiomyopathy, this scarring can raise the risk of dangerous heart rhythms and sudden cardiac death. Research shows that LGE-positive patients have a significantly higher risk of sudden cardiac death compared to those without LGE.

What the research says

A systematic review and meta-analysis of 15 studies including 2,494 patients who were candidates for cardiac resynchronization therapy (CRT) or implantable cardioverter-defibrillators (ICDs) found that LGE-positive patients had a 72% higher risk of sudden cardiac death (HR 1.72; 95% CI 1.18-2.50) compared to LGE-negative patients ². In patients with non-ischemic cardiomyopathy, the risk was even higher: LGE positivity was associated with a 142% increased risk (HR 2.42; 95% CI 1.99-2.94) ². Another study in hypertrophic cardiomyopathy patients found that serum levels of matrix metalloproteinase-9 (MMP-9), a marker of fibrosis, correlated with LGE burden and cardiac events like ventricular tachycardia, which can lead to sudden death ⁷. Additionally, in pediatric cardiomyopathy patients with TTN gene variants, LGE was identified in 56.67% of those who underwent MRI, and early age of onset was a risk factor for major adverse cardiovascular events ³. These findings support that LGE-CMR positivity is a marker of higher sudden death risk across different types of cardiomyopathy.

What to ask your doctor

• Does my LGE-CMR result change my risk of sudden cardiac death?
• Should I consider an ICD (implantable cardioverter-defibrillator) based on my LGE status?
• How often should I have follow-up imaging to monitor changes in LGE?
• Are there other tests, like blood biomarkers, that can help refine my risk?
• What lifestyle changes or medications might reduce my risk given my LGE positivity?