AIMS: There is insufficient evidence to implant a combined cardiac resynchronization therapy (CRT) device with defibrillation capabilities (CRT-D) in all CRT candidates. The aim of the study was to assess myocardial scar size and its heterogeneity as predictors of sudden cardiac death (SCD) in CRT candidates. METHODS AND RESULTS: A cohort of 78 consecutive patients with dilated cardiomyopathy and class I indication for CRT-D were prospectively enrolled. Before CRT-D implantation, a contrast-enhanced cardiac magnetic resonance (ce-CMR) was performed. The core and border zone (BZ) of the myocardial scar were characterized and quantified with a customized post-processing software. The first appropriate implantable cardioverter defibrillator (ICD) therapy was considered as a surrogate of SCD. During a mean follow-up of 25 months (25-75th percentiles, 15-34), appropriate ICD therapy occurred in 11.5% of patients. In a multivariate Cox proportional hazards regression model for clinical and ce-CMR variables, the scar mass percentage [hazards ratio (HR) per 1% increase 1.1 (1.06-1.15), P < 0.01], the BZ mass [HR per 1 g increase 1.06 (1.04-1.09), P < 0.01], and the BZ percentage of the scar [HR per 1% increase 1.06 (1.02-1.11), P < 0.01], were the only independent predictors of appropriate ICD therapy. Receiver-operating characteristic curve analysis showed that a scar mass <16% and a BZ < 9.5 g had a negative predictive value of 100%. CONCLUSIONS: The presence, size, and heterogeneity of myocardial scar independently predict appropriate ICD therapies in CRT candidates. The ce-CMR-based scar analysis might help identify a subgroup of patients at relatively low risk of SCD.
AIMS: There is insufficient evidence to implant a combined cardiac resynchronization therapy (CRT) device with defibrillation capabilities (CRT-D) in all CRT candidates. The aim of the study was to assess myocardial scar size and its heterogeneity as predictors of sudden cardiac death (SCD) in CRT candidates. METHODS AND RESULTS: A cohort of 78 consecutive patients with dilated cardiomyopathy and class I indication for CRT-D were prospectively enrolled. Before CRT-D implantation, a contrast-enhanced cardiac magnetic resonance (ce-CMR) was performed. The core and border zone (BZ) of the myocardial scar were characterized and quantified with a customized post-processing software. The first appropriate implantable cardioverter defibrillator (ICD) therapy was considered as a surrogate of SCD. During a mean follow-up of 25 months (25-75th percentiles, 15-34), appropriate ICD therapy occurred in 11.5% of patients. In a multivariate Cox proportional hazards regression model for clinical and ce-CMR variables, the scar mass percentage [hazards ratio (HR) per 1% increase 1.1 (1.06-1.15), P < 0.01], the BZ mass [HR per 1 g increase 1.06 (1.04-1.09), P < 0.01], and the BZ percentage of the scar [HR per 1% increase 1.06 (1.02-1.11), P < 0.01], were the only independent predictors of appropriate ICD therapy. Receiver-operating characteristic curve analysis showed that a scar mass <16% and a BZ < 9.5 g had a negative predictive value of 100%. CONCLUSIONS: The presence, size, and heterogeneity of myocardial scar independently predict appropriate ICD therapies in CRT candidates. The ce-CMR-based scar analysis might help identify a subgroup of patients at relatively low risk of SCD.
Authors: Yiyi Zhang; Eliseo Guallar; Robert G Weiss; Michael Stillabower; Gary Gerstenblith; Gordon F Tomaselli; Katherine C Wu Journal: Heart Rhythm Date: 2016-04-19 Impact factor: 6.343
Authors: Robert Jablonowski; Uzma Chaudhry; Jesper van der Pals; Henrik Engblom; Håkan Arheden; Einar Heiberg; Katherine C Wu; Rasmus Borgquist; Marcus Carlsson Journal: Circ Cardiovasc Imaging Date: 2017-09 Impact factor: 7.792
Authors: Zak Loring; David G Strauss; Gary Gerstenblith; Gordon F Tomaselli; Robert G Weiss; Katherine C Wu Journal: Heart Rhythm Date: 2013-01-08 Impact factor: 6.343