Juan Acosta1, Juan Fernández-Armenta1, Roger Borràs1, Ignasi Anguera2, Felipe Bisbal3, Julio Martí-Almor4, Jose M Tolosana1, Diego Penela1, David Andreu1, David Soto-Iglesias1, Reinder Evertz1, María Matiello5, Concepción Alonso6, Roger Villuendas3, Teresa M de Caralt7, Rosario J Perea7, Jose T Ortiz1, Xavier Bosch1, Luis Serra8, Xavier Planes8, Andreas Greiser9, Okan Ekinci10, Luis Lasalvia11, Lluis Mont1, Antonio Berruezo12. 1. Arrhythmia Section, Cardiology Department, Thorax Institute, Hospital Clínic and IDIBAPS (Institut d'Investigació Agustí Pi i Sunyer), University of Barcelona, Barcelona, Catalonia, Spain; CIBERCV, Instituto de Salud Carlos III, Madrid, Spain. 2. Cardiology Department, Heart Disease Institute, Bellvitge Biomedical Research Institute IDIBELL, Bellvitge Hospital, University of Barcelona, Spain. 3. CIBERCV, Instituto de Salud Carlos III, Madrid, Spain; Heart Institute (iCor), University Hospital Germans Trias i Pujol, Barcelona, Spain. 4. Electrophysiology Unit, Cardiovascular Division, Department of Medicine, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain. 5. Arrhythmia Section, Cardiology Department, Catalonia General Hospital, Barcelona, Spain. 6. Arrhythmia Unit, Cardiology Department, Hospital de la Sta. Creu i St. Pau, Barcelona, Spain. 7. Radiology Department, Hospital Clinic, University of Barcelona, Barcelona, Catalonia, Spain. 8. Galgo Medical, SL, Barcelona, Spain. 9. Siemens Healthcare GmbH, Erlangen, Germany. 10. Siemens Healthineers, Chief Medical Office, Erlangen, Germany; University College Dublin, School of Medicine, Dublin, Ireland. 11. Siemens Medical Solutions, Global Clinical Marketing, Siemens Healthineers, New York, New York. 12. Arrhythmia Section, Cardiology Department, Thorax Institute, Hospital Clínic and IDIBAPS (Institut d'Investigació Agustí Pi i Sunyer), University of Barcelona, Barcelona, Catalonia, Spain; CIBERCV, Instituto de Salud Carlos III, Madrid, Spain. Electronic address: berruezo@clinic.ub.es.
Abstract
OBJECTIVES: The aim of this study was to analyze whether scar characterization could improve the risk stratification for life-threatening ventricular arrhythmias and sudden cardiac death (SCD). BACKGROUND: Among patients with a cardiac resynchronization therapy (CRT) indication, appropriate defibrillator (CRT-D) therapy rates are low. METHODS: Primary prevention patients with a class I indication for CRT were prospectively enrolled and assigned to CRT-D or CRT pacemaker according to physician's criteria. Pre-procedure contrast-enhanced cardiac magnetic resonance was obtained and analyzed to identify scar presence or absence, quantify the amount of core and border zone (BZ), and depict BZ distribution. The presence, mass, and characteristics of BZ channels in the scar were recorded. The primary endpoint was appropriate defibrillator therapy or SCD. RESULTS: 217 patients (39.6% ischemic) were included. During a median follow-up of 35.5 months (12 to 62 months), the primary endpoint occurred in 25 patients (11.5%) and did not occur in patients without myocardial scar. Among patients with scar (n = 125, 57.6%), those with implantable cardioverter-defibrillator (ICD) therapies or SCD exhibited greater scar mass (38.7 ± 34.2 g vs. 17.9 ± 17.2 g; p < 0.001), scar heterogeneity (BZ mass/scar mass ratio) (49.5 ± 13.0 vs. 40.1 ± 21.7; p = 0.044), and BZ channel mass (3.6 ± 3.0 g vs. 1.8 ± 3.4 g; p = 0.018). BZ mass (hazard ratio: 1.06 [95% confidence interval: 1.04 to 1.08]; p < 0.001) and BZ channel mass (hazard ratio: 1.21 [95% confidence interval: 1.10 to 1.32]; p < 0.001) were the strongest predictors of the primary endpoint. An algorithm based on scar mass and the absence of BZ channels identified 148 patients (68.2%) without ICD therapy/SCD during follow-up with a 100% negative predictive value. CONCLUSIONS: The presence, extension, heterogeneity, and qualitative distribution of BZ tissue of myocardial scar independently predict appropriate ICD therapies and SCD in CRT patients.
OBJECTIVES: The aim of this study was to analyze whether scar characterization could improve the risk stratification for life-threatening ventricular arrhythmias and sudden cardiac death (SCD). BACKGROUND: Among patients with a cardiac resynchronization therapy (CRT) indication, appropriate defibrillator (CRT-D) therapy rates are low. METHODS: Primary prevention patients with a class I indication for CRT were prospectively enrolled and assigned to CRT-D or CRT pacemaker according to physician's criteria. Pre-procedure contrast-enhanced cardiac magnetic resonance was obtained and analyzed to identify scar presence or absence, quantify the amount of core and border zone (BZ), and depict BZ distribution. The presence, mass, and characteristics of BZ channels in the scar were recorded. The primary endpoint was appropriate defibrillator therapy or SCD. RESULTS: 217 patients (39.6% ischemic) were included. During a median follow-up of 35.5 months (12 to 62 months), the primary endpoint occurred in 25 patients (11.5%) and did not occur in patients without myocardial scar. Among patients with scar (n = 125, 57.6%), those with implantable cardioverter-defibrillator (ICD) therapies or SCD exhibited greater scar mass (38.7 ± 34.2 g vs. 17.9 ± 17.2 g; p < 0.001), scar heterogeneity (BZ mass/scar mass ratio) (49.5 ± 13.0 vs. 40.1 ± 21.7; p = 0.044), and BZ channel mass (3.6 ± 3.0 g vs. 1.8 ± 3.4 g; p = 0.018). BZ mass (hazard ratio: 1.06 [95% confidence interval: 1.04 to 1.08]; p < 0.001) and BZ channel mass (hazard ratio: 1.21 [95% confidence interval: 1.10 to 1.32]; p < 0.001) were the strongest predictors of the primary endpoint. An algorithm based on scar mass and the absence of BZ channels identified 148 patients (68.2%) without ICD therapy/SCD during follow-up with a 100% negative predictive value. CONCLUSIONS: The presence, extension, heterogeneity, and qualitative distribution of BZ tissue of myocardial scar independently predict appropriate ICD therapies and SCD in CRT patients.
Authors: Sören J Backhaus; Simon F Rösel; Thomas Stiermaier; Jonas Schmidt-Rimpler; Ruben Evertz; Alexander Schulz; Torben Lange; Johannes T Kowallick; Shelby Kutty; Boris Bigalke; Matthias Gutberlet; Gerd Hasenfuß; Holger Thiele; Ingo Eitel; Andreas Schuster Journal: Eur Heart J Open Date: 2022-08-12
Authors: Brendan L Eck; Scott D Flamm; Deborah H Kwon; W H Wilson Tang; Claudia Prieto Vasquez; Nicole Seiberlich Journal: Prog Nucl Magn Reson Spectrosc Date: 2020-11-06 Impact factor: 9.795