Yoko Mikami1, Umjeet Jolly1, Bobak Heydari1, Mingkai Peng1, Fahad Almehmadi1, Mohammed Zahrani1, Mahmoud Bokhari1, John Stirrat1, Carmen P Lydell1, Andrew G Howarth1, Raymond Yee1, James A White2. 1. From the Stephenson Cardiac Imaging Centre (Y.M., B.H., C.P.L., A.G.H., J.W.) and Department of Cardiac Sciences (Y.M., B.H., M.P., C.P.L., A.G.H., J.W.), Libin Cardiovascular Institute of Alberta, University of Calgary, Canada; Department of Diagnostic Imaging, University of Calgary, Alberta, Canada (B.H., C.P.L., A.G.H., J.W.); and Department of Medicine, London Health Sciences Centre, Ontario, Canada (U.J., F.A., M.Z., M.B., J.S., R.Y.). 2. From the Stephenson Cardiac Imaging Centre (Y.M., B.H., C.P.L., A.G.H., J.W.) and Department of Cardiac Sciences (Y.M., B.H., M.P., C.P.L., A.G.H., J.W.), Libin Cardiovascular Institute of Alberta, University of Calgary, Canada; Department of Diagnostic Imaging, University of Calgary, Alberta, Canada (B.H., C.P.L., A.G.H., J.W.); and Department of Medicine, London Health Sciences Centre, Ontario, Canada (U.J., F.A., M.Z., M.B., J.S., R.Y.). jawhit@ucalgary.ca.
Abstract
BACKGROUND: Left ventricular ejection fraction remains the primary risk stratification tool used in the selection of patients for implantable cardioverter defibrillator therapy. However, this solitary marker fails to identify a substantial portion of patients experiencing sudden cardiac arrest. In this study, we examined the incremental value of considering right ventricular ejection fraction for the prediction of future arrhythmic events in patients with systolic dysfunction using the gold standard of cardiovascular magnetic resonance. METHODS AND RESULTS: Three hundred fourteen consecutive patients with ischemic cardiomyopathy or nonischemic dilated cardiomyopathy undergoing cardiovascular magnetic resonance were followed for the primary outcome of sudden cardiac arrest or appropriate implantable cardioverter defibrillator therapy. Blinded quantification of left ventricular and right ventricular (RV) volumes was performed from standard cine imaging. Quantification of fibrosis from late gadolinium enhancement imaging was incrementally performed. RV dysfunction was defined as right ventricular ejection fraction ≤45%. Among all patients (164 ischemic cardiomyopathy, 150 nonischemic dilated cardiomyopathy), the mean left ventricular ejection fraction was 32±12% (range, 6-54%) with mean right ventricular ejection fraction of 48±15% (range, 7-78%). At a median of 773 days, 49 patients (15.6%) experienced the primary outcome (9 sudden cardiac arrest, 40 appropriate implantable cardioverter defibrillator therapies). RV dysfunction was independently predictive of the primary outcome (hazard ratio=2.98; P=0.002). Among those with a left ventricular ejection fraction >35% (N=121; mean left ventricular ejection fraction, 45±6%), RV dysfunction provided an adjusted hazard ratio of 4.2 (P=0.02). CONCLUSIONS: RV dysfunction is a strong, independent predictor of arrhythmic events. Among patients with mild to moderate LV dysfunction, a cohort greatly contributing to global sudden cardiac arrest burden, this marker provides robust discrimination of high- versus low-risk subjects.
BACKGROUND: Left ventricular ejection fraction remains the primary risk stratification tool used in the selection of patients for implantable cardioverter defibrillator therapy. However, this solitary marker fails to identify a substantial portion of patients experiencing sudden cardiac arrest. In this study, we examined the incremental value of considering right ventricular ejection fraction for the prediction of future arrhythmic events in patients with systolic dysfunction using the gold standard of cardiovascular magnetic resonance. METHODS AND RESULTS: Three hundred fourteen consecutive patients with ischemic cardiomyopathy or nonischemic dilated cardiomyopathy undergoing cardiovascular magnetic resonance were followed for the primary outcome of sudden cardiac arrest or appropriate implantable cardioverter defibrillator therapy. Blinded quantification of left ventricular and right ventricular (RV) volumes was performed from standard cine imaging. Quantification of fibrosis from late gadolinium enhancement imaging was incrementally performed. RV dysfunction was defined as right ventricular ejection fraction ≤45%. Among all patients (164 ischemic cardiomyopathy, 150 nonischemic dilated cardiomyopathy), the mean left ventricular ejection fraction was 32±12% (range, 6-54%) with mean right ventricular ejection fraction of 48±15% (range, 7-78%). At a median of 773 days, 49 patients (15.6%) experienced the primary outcome (9 sudden cardiac arrest, 40 appropriate implantable cardioverter defibrillator therapies). RV dysfunction was independently predictive of the primary outcome (hazard ratio=2.98; P=0.002). Among those with a left ventricular ejection fraction >35% (N=121; mean left ventricular ejection fraction, 45±6%), RV dysfunction provided an adjusted hazard ratio of 4.2 (P=0.02). CONCLUSIONS:RV dysfunction is a strong, independent predictor of arrhythmic events. Among patients with mild to moderate LV dysfunction, a cohort greatly contributing to global sudden cardiac arrest burden, this marker provides robust discrimination of high- versus low-risk subjects.
Authors: Akhil Vaid; Kipp W Johnson; Marcus A Badgeley; Sulaiman S Somani; Mesude Bicak; Isotta Landi; Adam Russak; Shan Zhao; Matthew A Levin; Robert S Freeman; Alexander W Charney; Atul Kukar; Bette Kim; Tatyana Danilov; Stamatios Lerakis; Edgar Argulian; Jagat Narula; Girish N Nadkarni; Benjamin S Glicksberg Journal: JACC Cardiovasc Imaging Date: 2021-10-13
Authors: Aidan K Cornhill; Steven Dykstra; Alessandro Satriano; Dina Labib; Yoko Mikami; Jacqueline Flewitt; Easter Prosio; Sandra Rivest; Rosa Sandonato; Andrew G Howarth; Carmen Lydell; Cathy A Eastwood; Hude Quan; Nowell Fine; Joon Lee; James A White Journal: Front Cardiovasc Med Date: 2022-06-16
Authors: Marthe A J Becker; Anne-Lotte C J van der Lingen; Marc Wubben; Peter M van de Ven; Albert C van Rossum; Jan H Cornel; Cornelis P Allaart; Tjeerd Germans Journal: ESC Heart Fail Date: 2021-02-09
Authors: Katherine C Wu; Hiroshi Ashikaga; Julian Krebs; Tommaso Mansi; Hervé Delingette; Bin Lou; Joao A C Lima; Susumu Tao; Luisa A Ciuffo; Sanaz Norgard; Barbara Butcher; Wei H Lee; Ela Chamera; Timm-Michael Dickfeld; Michael Stillabower; Joseph E Marine; Robert G Weiss; Gordon F Tomaselli; Henry Halperin Journal: Sci Rep Date: 2021-11-22 Impact factor: 4.996