1. Usefulness of late gadolinium enhancement cardiac magnetic resonance to predict appropriate therapies in implantable cardioverter defibrillator patients in primary prevention
- Author
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Jacques Ortiz, Gala Caixal, F Alarcon, F Zarakett, I Roca, Antonio Berruezo, P Sanchez Somonte, M Pujol, Elena Arbelo, Levio Quinto, Beatriz Jáuregui, José María Tolosana, Eduard Guasch, Luis Mont, and Paz Garre
- Subjects
medicine.medical_specialty ,Ischemic cardiomyopathy ,Ejection fraction ,business.industry ,Gadolinium ,medicine.medical_treatment ,Ischemia ,chemistry.chemical_element ,Implantable cardioverter-defibrillator ,medicine.disease ,Sudden cardiac death ,chemistry ,Linear gingival erythema ,Internal medicine ,medicine ,Cardiology ,Cardiology and Cardiovascular Medicine ,business ,Endocardium - Abstract
Background The scar and the amount of border zone measured by late gadolinium enhancement cardiac magnetic resonance (LGE-CMR) has been proposed as an independent predictor of ventricular arrhythmias in patients with ischemic and non-ischemic cardiomyopathy. However, at the present time, the guidelines are based only on the ejection fraction to recommend an implantable cardioverter defibrillator (ICD) in primary prevention, and only a minority of these patients receive appropriate therapies. So, prevention needs to be improved. Purpose To identify predictors of appropriate therapies in patients with a primary prevention ICD using cardiac magnetic resonance imaging and a dedicated software (ADAS-3D) to characterize the scar. Methods Patients who underwent a LGE-MR prior to ICD implantation in primary prevention were retrospectively included. Clinical and cardiac imaging characteristics were collected. The myocardium was segmented with ADAS-3D software in 10 layers (from endocardium to epicardium). The scar, border zone, core and conducting channels were automatically measured in grams by the software. Results Since 2008 to 2017, 206 patients were included. Mean age was 67±28 years, 80% men, mean ejection fraction 26%±9, 52% with ischemic cardiomyopathy and 48% non-ischemic. The primary endpoint was appropriate therapies and/or sudden cardiac death (SCD). Median follow-up was 46.33 months. 46 patients (22%) reached the primary endpoint. Greater scar mass (36.05 grams vs 21.5 grams; HR 1.04; 95% CI (1.03–1-05), p5.3 grams was independently associated with the primary endpoint (HR: 4.77; 95% CI (1.15–19.73), p=0.03). Conclusions The amount of border zone, core and channel mass measured by LGE-MR and ADAS software are independent predictors of appropriate therapies and SCD in patients with ICD in primary prevention. Scar characterization Funding Acknowledgement Type of funding source: None
- Published
- 2020