- Email: [email protected]
THE IMPACT OF MYOCARDIAL SCAR BY CARDIAC MAGNETIC RESONANCE IN PATIENTS WITH NONISCHEMIC DILATED CARDIOMYOPATHY REFERRED FOR AN IMPLANTABLE CARDIOVERTER DEFIBRILLATOR FOR PRIMARY PREVENTION OF SUDDEN CARDIAC DEATH
E866 JACC March 27, 2012 Volume 59, Issue 13
Heart Failure THE IMPACT OF MYOCARDIAL SCAR BY CARDIAC MAGNETIC RESONANCE IN PATIENTS WITH NON-ISCHEMIC DILATED CARDIOMYOPATHY REFERRED FOR AN IMPLANTABLE CARDIOVERTER DEFIBRILLATOR FOR PRIMARY PREVENTION OF SUDDEN CARDIAC DEATH ACC Oral Contributions McCormick Place South, S405 Sunday, March 25, 2012, 10:45 a.m.-11:00 a.m.
Session Title: Improving Patient Selection for Device-Based Therapies Abstract Category: 13. Heart Failure: Therapy Presentation Number: 922-3 Authors: Tomas G. Neilan, Otavio Coelho-Filho, Stephan Danik, Daniel J. Verdini, Tokuda Michifumi, Ravi Shah, Usha Tedrow, William Stevenson, Michael Jerosch-Herold, Brian Ghoshhajra, Raymond Kwong, Brigham and Women’s Hospital, Boston, MA, USA, Massachusettes General Hospital, Boston, MA, USA Background: Patients with non-ischemic dilated cardiomyopathy NIDC are at risk of arrhythmias and sudden cardiac death (SCD). The likely arrhythmia substrate is myocardial fibrosis. We tested the hypothesis that the presence and extent of fibrosis characterized by late gadolinium enhancement (LGE) cardiac magnetic resonance (CMR) may help risk stratify patients with NIDC referred for an implantable cardioverter defibrillator (ICD) therapy for primary prevention of SCD. Methods: One hundred and nine patients ((61% male, mean age of 50±14 years, mean left ventricular ejection fraction of 25±9%) with a class 1 indication for ICD insertion for primary prevention of SCD at two institutions underwent an LGE-CMR study and were prospectively followed. Events of interest were defined as a combination of death and appropriate ICD therapy. Results: Myocardial fibrosis by LGE-CMR was identified in 59 patients (54%). During the median follow-up period of 34 months there were 30 events (10 deaths and 20 appropriate ICD therapies). Univariate analysis showed that the presence and the extent of LGE demonstrated the strongest unadjusted association with cardiac events (LGE, hazard ratio (HR): 5.8, chi-squared 12.7, P<0.001; LGE extent, HR 1.16 per 1% increase in LGE extent, chi-squared 40.1, P<0.001). In multivariable analysis, the presence of LGE predicted cardiac events independent of age, gender, functional class, and ejection fraction. Patients with LGE had a combined event rate of 15% per year, a mortality rate of 5.5% per year, and an ICD therapy rate of 9.5% per year in comparison to LGE negative patients who had a combined event rate of 2.6% per year, a mortality rate of 0.7% per year and an ICD therapy rate of 1.9% per year. When the extent of LGE was quantified, patients with an LGE extent of >5.6% had an overall event rate of 23% per year. Conclusions: LGE is a powerful marker of risk in patients with NIDC who meet criteria for ICD insertion.
Heart Failure THE IMPACT OF MYOCARDIAL SCAR BY CARDIAC MAGNETIC RESONANCE IN PATIENTS WITH NON-ISCHEMIC DILATED CARDIOMYOPATHY REFERRED FOR AN IMPLANTABLE CARDIOVERTER DEFIBRILLATOR FOR PRIMARY PREVENTION OF SUDDEN CARDIAC DEATH ACC Oral Contributions McCormick Place South, S405 Sunday, March 25, 2012, 10:45 a.m.-11:00 a.m.
Session Title: Improving Patient Selection for Device-Based Therapies Abstract Category: 13. Heart Failure: Therapy Presentation Number: 922-3 Authors: Tomas G. Neilan, Otavio Coelho-Filho, Stephan Danik, Daniel J. Verdini, Tokuda Michifumi, Ravi Shah, Usha Tedrow, William Stevenson, Michael Jerosch-Herold, Brian Ghoshhajra, Raymond Kwong, Brigham and Women’s Hospital, Boston, MA, USA, Massachusettes General Hospital, Boston, MA, USA Background: Patients with non-ischemic dilated cardiomyopathy NIDC are at risk of arrhythmias and sudden cardiac death (SCD). The likely arrhythmia substrate is myocardial fibrosis. We tested the hypothesis that the presence and extent of fibrosis characterized by late gadolinium enhancement (LGE) cardiac magnetic resonance (CMR) may help risk stratify patients with NIDC referred for an implantable cardioverter defibrillator (ICD) therapy for primary prevention of SCD. Methods: One hundred and nine patients ((61% male, mean age of 50±14 years, mean left ventricular ejection fraction of 25±9%) with a class 1 indication for ICD insertion for primary prevention of SCD at two institutions underwent an LGE-CMR study and were prospectively followed. Events of interest were defined as a combination of death and appropriate ICD therapy. Results: Myocardial fibrosis by LGE-CMR was identified in 59 patients (54%). During the median follow-up period of 34 months there were 30 events (10 deaths and 20 appropriate ICD therapies). Univariate analysis showed that the presence and the extent of LGE demonstrated the strongest unadjusted association with cardiac events (LGE, hazard ratio (HR): 5.8, chi-squared 12.7, P<0.001; LGE extent, HR 1.16 per 1% increase in LGE extent, chi-squared 40.1, P<0.001). In multivariable analysis, the presence of LGE predicted cardiac events independent of age, gender, functional class, and ejection fraction. Patients with LGE had a combined event rate of 15% per year, a mortality rate of 5.5% per year, and an ICD therapy rate of 9.5% per year in comparison to LGE negative patients who had a combined event rate of 2.6% per year, a mortality rate of 0.7% per year and an ICD therapy rate of 1.9% per year. When the extent of LGE was quantified, patients with an LGE extent of >5.6% had an overall event rate of 23% per year. Conclusions: LGE is a powerful marker of risk in patients with NIDC who meet criteria for ICD insertion.