Response by Halliday et al to Letter Regarding Article, 'Association Between Midwall Late Gadolinium Enhancement and Sudden Cardiac Death in Patients with Dilated Cardiomyopathy and Mild and Moderate Left Ventricular Systolic Dysfunction'

摘要

We thank Dr Locorotondo and colleagues for their kind comments regarding our recently published article.~1 We agree that, although the quantification of midwall late gadolinium enhancement (LGE) in dilated cardiomyopathy has been shown to be reproducible between operators in the same center using a single technique, it is not known whether this remains the case when examining operators in different centers using different techniques.~2 Quantification of LGE relies on a degree of subjective interpretation, and this appears to be a major barrier to the use of cutoff values within clinical practice. In addition, the exact relationship between the extent of LGE and specific outcomes in patients with dilated cardiomyopathy remains uncertain. Examining the association between LGE extent and outcome using proportional hazard modeling assumes a linear dose-dependent relationship, and whether this truly exists is currently unclear. The association between the location and pattern of LGE and outcome is another important area for evaluation. Based on available evidence, our preferred approach to predicting adverse risk is one considering the binary presence or absence of midwall LGE rather than one taking into account the extent.~3