Does late gadolinium enhancement predict cardiac events in patients with ischemic cardiomyopathy?

Despite improved clinical care and heightened public awareness, myocardial infarction (MI) and sudden cardiac death remain the leading causes of death in the United States.1 For this reason, clinical,2 laboratory,3 and electrocardiographic4 markers to identify those at risk for future cardiac events have been developed. In addition, both invasive (contrast angiography)5,6 and noninvasive (transthoracic echocardiography,7 radionuclide scintigraphy,8 magnetic resonance,9 and computer tomography10) imaging markers have been identified that further supplement the clinical markers to more accurately define cardiac risk. For the most part, these imaging markers rely on rest or stress measures of left ventricular (LV) ejection fraction,11 regional wall motion,12 myocardial perfusion,13 or the extent of coronary atherosclerosis.14 With the exception of coronary artery calcification scoring generated from computer tomography image datasets,15 there have been few new imaging markers (introduced during the past 15 years) that add incremental benefit to our ability to identify cardiac risk.