Gianluca Pontone1, Andrea I Guaricci2, Daniele Andreini2, Anna Solbiati2, Marco Guglielmo2, Saima Mushtaq2, Andrea Baggiano2, Virginia Beltrama2, Laura Fusini2, Cristina Rota2, Chiara Segurini2, Edoardo Conte2, Paola Gripari2, Antonio Dello Russo2, Massimo Moltrasio2, Fabrizio Tundo2, Federico Lombardi2, Giuseppe Muscogiuri2, Valentina Lorenzoni2, Claudio Tondo2, Piergiuseppe Agostoni2, Antonio L Bartorelli2, Mauro Pepi2. 1. From the Centro Cardiologico Monzino, IRCCS, Milan, Italy (G.P., D.A., M.G., S.M., A.B., V.B., L.F., C.S., E.C., P.G., A.D.R., M.M., F.T., C.T., P.A., A.L.B., M.P.); Department of Emergency and Organ Transplantation, Institute of Cardiovascular Disease, University Hospital Policlinico Consorziale of Bari, Italy (A.I.G.); Department of Medical and Surgical Sciences, University of Foggia, Italy (A.I.G.); Department of Cardiovascular Sciences and Community Health, University of Milan, Italy (D.A., A.S., C.R., F.L., P.A.); UOC Malattie Cardiovascolari, Fondazione IRCCS Ospedale Maggiore Policlinico, Milan, Italy (F.L.); Department of Imaging, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy (G.M.); Istituto di Management, Scuola Superiore Sant'Anna, Pisa, Italy (V.L.); and Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Italy (A.L.B.). gianluca.pontone@ccfm.it. 2. From the Centro Cardiologico Monzino, IRCCS, Milan, Italy (G.P., D.A., M.G., S.M., A.B., V.B., L.F., C.S., E.C., P.G., A.D.R., M.M., F.T., C.T., P.A., A.L.B., M.P.); Department of Emergency and Organ Transplantation, Institute of Cardiovascular Disease, University Hospital Policlinico Consorziale of Bari, Italy (A.I.G.); Department of Medical and Surgical Sciences, University of Foggia, Italy (A.I.G.); Department of Cardiovascular Sciences and Community Health, University of Milan, Italy (D.A., A.S., C.R., F.L., P.A.); UOC Malattie Cardiovascolari, Fondazione IRCCS Ospedale Maggiore Policlinico, Milan, Italy (F.L.); Department of Imaging, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy (G.M.); Istituto di Management, Scuola Superiore Sant'Anna, Pisa, Italy (V.L.); and Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Italy (A.L.B.).
Abstract
BACKGROUND: The aim of this study was to determine the prognostic benefit of cardiac magnetic resonance (CMR) over transthoracic echocardiography (TTE) in ischemic cardiomyopathy and nonischemic dilated cardiomyopathy patients evaluated for primary prevention implantable cardioverter-defibrillator therapy. METHODS AND RESULTS: We enrolled 409 consecutive ischemic and dilated cardiomyopathy patients (mean age: 64±12 years; 331 men). All patients underwent TTE and CMR, and left ventricle end-diastolic volume, left ventricle end-systolic volume, and left ventricle ejection fraction (LVEF) were evaluated. In addition, late gadolinium enhancement was also assessed. All patients were followed up for major adverse cardiac events (MACE) defined as a composite end point of long runs of nonsustained ventricular tachycardia, sustained ventricular tachycardia, aborted sudden cardiac death, or sudden cardiac death. The median follow-up was 545 days. CMR showed higher left ventricle end-diastolic volume (mean difference: 43±22.5 mL), higher left ventricle end-systolic volume (mean difference: 34±20.5 mL), and lower LVEF (mean difference: -4.9±10%) as compared to TTE (P<0.01). MACE occurred in 103 (25%) patients. Patients experiencing MACE showed higher left ventricle end-diastolic volume, higher left ventricle end-systolic volume, and lower LVEF with both imaging modalities and higher late gadolinium enhancement per-patient prevalence as compared to patients without MACE. At multivariable analysis, CMR-LVEF ≤35% (hazard ratio=2.18 [1.3-3.8]) and the presence of late gadolinium enhancement (hazard ratio=2.2 [1.4-3.6]) were independently associated with MACE (P<0.01). A model based on CMR-LVEF ≤35% or CMR-LVEF ≤35% plus late gadolinium enhancement detection showed a higher performance in the prediction of MACE as compared to TTE-LVEF resulting in net reclassification improvement of 0.468 (95% confidence interval, 0.283-0.654; P<0.001) and 0.413 (95% confidence interval, 0.23-0.63; P<0.001), respectively. CONCLUSIONS: CMR provides additional prognostic stratification as compared to TTE, which may have direct impact on the indication of implantable cardioverter-defibrillator implantation.
BACKGROUND: The aim of this study was to determine the prognostic benefit of cardiac magnetic resonance (CMR) over transthoracic echocardiography (TTE) in ischemic cardiomyopathy and nonischemic dilated cardiomyopathypatients evaluated for primary prevention implantable cardioverter-defibrillator therapy. METHODS AND RESULTS: We enrolled 409 consecutive ischemic and dilated cardiomyopathypatients (mean age: 64±12 years; 331 men). All patients underwent TTE and CMR, and left ventricle end-diastolic volume, left ventricle end-systolic volume, and left ventricle ejection fraction (LVEF) were evaluated. In addition, late gadolinium enhancement was also assessed. All patients were followed up for major adverse cardiac events (MACE) defined as a composite end point of long runs of nonsustained ventricular tachycardia, sustained ventricular tachycardia, aborted sudden cardiac death, or sudden cardiac death. The median follow-up was 545 days. CMR showed higher left ventricle end-diastolic volume (mean difference: 43±22.5 mL), higher left ventricle end-systolic volume (mean difference: 34±20.5 mL), and lower LVEF (mean difference: -4.9±10%) as compared to TTE (P<0.01). MACE occurred in 103 (25%) patients. Patients experiencing MACE showed higher left ventricle end-diastolic volume, higher left ventricle end-systolic volume, and lower LVEF with both imaging modalities and higher late gadolinium enhancement per-patient prevalence as compared to patients without MACE. At multivariable analysis, CMR-LVEF ≤35% (hazard ratio=2.18 [1.3-3.8]) and the presence of late gadolinium enhancement (hazard ratio=2.2 [1.4-3.6]) were independently associated with MACE (P<0.01). A model based on CMR-LVEF ≤35% or CMR-LVEF ≤35% plus late gadolinium enhancement detection showed a higher performance in the prediction of MACE as compared to TTE-LVEF resulting in net reclassification improvement of 0.468 (95% confidence interval, 0.283-0.654; P<0.001) and 0.413 (95% confidence interval, 0.23-0.63; P<0.001), respectively. CONCLUSIONS: CMR provides additional prognostic stratification as compared to TTE, which may have direct impact on the indication of implantable cardioverter-defibrillator implantation.
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Authors: Gianluca Pontone; Alexia Rossi; Marco Guglielmo; Marc R Dweck; Oliver Gaemperli; Koen Nieman; Francesca Pugliese; Pal Maurovich-Horvat; Alessia Gimelli; Bernard Cosyns; Stephan Achenbach Journal: Eur Heart J Cardiovasc Imaging Date: 2022-03-22 Impact factor: 9.130
Authors: Gianluca Pontone; Patrizia Carità; Mark G Rabbat; Marco Guglielmo; Andrea Baggiano; Giuseppe Muscogiuri; Andrea I Guaricci Journal: Curr Cardiol Rep Date: 2017-08-31 Impact factor: 2.931