Scar Characterization to Predict Life-Threatening Arrhythmic Events and Sudden Cardiac Death in Patients With Cardiac Resynchronization Therapy: The GAUDI-CRT Study
| Autor: | Acosta, Juan, Fernández Armenta, Juan, Borras, Roger, Anguera Camós, Ignasi, Bisbal, Felipe, Martí Almor, Julio, Tolosana, José M. (José María), Penela, Diego, Andreu, David, Soto Iglesias, David, Evertz, Reinder, Matiello, María, Alonso, Concepción, Villuendas, Roger, Caralt Robira, Ma. Teresa de, Perea, Rosario J., Ortiz, Jose T., Bosch José, Francesc Xavier, 1947, Serra, Luis, Planes, Xavier, Greiser, Andreas, Ekinci, Okan, Lasalvia, Luis, Mont Girbau, Lluís, Berruezo, Antonio |
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| Rok vydání: | 2018 |
| Předmět: |
Male
Time Factors Heart diseases Vascular damage Radboud Institute for Health Sciences [Radboudumc 16] Arritmia Arrítmia cardiac resynchronization therapy Risk Assessment sudden cardiac death Malalties del cor Cardiac Resynchronization Therapy Cicatrix Predictive Value of Tests Risk Factors Humans magnetic resonance imaging Prospective Studies Aged Heart Failure Myocardium ventricular arrhythmias Arrhythmias Cardiac Middle Aged Magnetic Resonance Imaging Primary Prevention Death Sudden Cardiac Treatment Outcome Spain Female Cardiomyopathies Arrhythmia |
| Zdroj: | JACC. Cardiovascular Imaging, 11, 4, pp. 561-572 JACC-CARDIOVASCULAR IMAGING r-IGTP. Repositorio Institucional de Producción Científica del Instituto de Investigación Germans Trias i Pujol instname Dipòsit Digital de la UB Universidad de Barcelona JACC-Cardiovascular Imaging r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau JACC. Cardiovascular Imaging, 11, 561-572 |
| ISSN: | 1936-878X |
| Popis: | 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. (c) 2018 by the American College of Cardiology Foundation. |
| Databáze: | OpenAIRE |
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