Alan Kiang, Danah Al-Deiri, Tom Kai Ming Wang, Reza Nezafat, Diane Rizkallah, Thomas D Callahan, Justin Z Lee, Pasquale Santangeli, Oussama M Wazni, Niraj Varma, Christopher Nguyen, Jakub Sroubek, Deborah Kwon
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Growing evidence suggests that cardiac magnetic resonance (CMR) imaging may be useful in this regard.</p><p><strong>Objective: </strong>We aimed to determine if late gadolinium enhancement (LGE) seen on CMR (dichotomized as none or minimal <2% vs significant ≥2%) predicts appropriate ICD therapies (primary endpoint) or all-cause mortality/transplant/left-ventricular assist device (LVAD) implantation (secondary endpoint) in patients with NICM.</p><p><strong>Methods: </strong>We identified 344 patients with NICM who underwent primary prevention ICD implantation at Cleveland Clinic between 2003 and 2021 with CMR within 12 months before implant. LGE was calculated as percentage myocardium with pixel intensity ≥5 standard deviations higher than that of reference myocardium. Endpoints were adjudicated retrospectively by chart review.</p><p><strong>Results: </strong>A total of 125 of 344 patients (36%) had none or minimal LGE, and 219 (64%) had significant LGE. Over a median follow-up of 61 months, 53 patients (24%) with significant LGE vs 10 (8%) with none or minimal LGE met the primary endpoint, and 56 patients (26%) vs 21 (17%) met the secondary endpoint, respectively. Significant LGE predicted the primary outcome in multivariable competing-risks regression (hazard ratio [HR] 2.99, 95% confidence interval [CI] 1.48-6.02, P = .002), but did not predict the secondary outcome in multivariable Cox regression (HR 1.34, 95% CI 0.78-2.29, P = .287).</p><p><strong>Conclusion: </strong>In patients with NICM and primary prevention ICDs, LGE ≥2% is predictive of appropriate device therapies but not all-cause mortality/LVAD/transplant. 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Over a median follow-up of 61 months, 53 patients (24%) with significant LGE vs 10 (8%) with none or minimal LGE met the primary endpoint, and 56 patients (26%) vs 21 (17%) met the secondary endpoint, respectively. Significant LGE predicted the primary outcome in multivariable competing-risks regression (hazard ratio [HR] 2.99, 95% confidence interval [CI] 1.48-6.02, P = .002), but did not predict the secondary outcome in multivariable Cox regression (HR 1.34, 95% CI 0.78-2.29, P = .287).</p><p><strong>Conclusion: </strong>In patients with NICM and primary prevention ICDs, LGE ≥2% is predictive of appropriate device therapies but not all-cause mortality/LVAD/transplant. 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引用次数: 0
摘要
背景：需要更好的风险分层来评估非缺血性心肌病（NICM）患者是否需要预防性植入式心律转复除颤器（ICD）。越来越多的证据表明，心脏磁共振成像（CMR）可能在这方面有用。目的：我们的目的是确定晚期钆增强（LGE）是否出现在CMR上。方法：我们确定了344例NICM患者，他们在2003-2021年期间在克利夫兰诊所接受了一级预防ICD植入，并在植入前12个月内进行了CMR。LGE以像素强度比对照心肌高≥5个标准差的心肌百分比计算。终点通过图表回顾判定。结果：344例患者中有125例（36%）无/轻微LGE， 219例（64%）有显著LGE。在61个月的中位随访中，53例（24%）显著LGE患者达到主要终点，10例（8%）无/轻微LGE患者达到次要终点，56例（26%）患者达到次要终点，21例（17%）患者达到次要终点。显著LGE预测多变量竞争风险回归的主要结局（风险比2.99,95% CI 1.48 ~ 6.02, p=0.002），但不能预测多变量Cox回归的次要结局（风险比1.34,95% CI 0.78 ~ 2.29, p=0.287）。结论：在NICM和一级预防ICD患者中，LGE≥2%可预测适当的器械治疗，但不能预测全因死亡率/LVAD/移植。LGE可能是心脏骤停风险的一个相对特定的预测因子，因此可以潜在地用于评估预防性ICD植入。
Late-gadolinium enhancement predicts appropriate device therapies in nonischemic recipients of primary prevention implantable cardioverter-defibrillators.
Background: Better risk stratification is needed to evaluate patients with nonischemic cardiomyopathy (NICM) for prophylactic implantable cardioverter-defibrillators (ICDs). Growing evidence suggests that cardiac magnetic resonance (CMR) imaging may be useful in this regard.
Objective: We aimed to determine if late gadolinium enhancement (LGE) seen on CMR (dichotomized as none or minimal <2% vs significant ≥2%) predicts appropriate ICD therapies (primary endpoint) or all-cause mortality/transplant/left-ventricular assist device (LVAD) implantation (secondary endpoint) in patients with NICM.
Methods: We identified 344 patients with NICM who underwent primary prevention ICD implantation at Cleveland Clinic between 2003 and 2021 with CMR within 12 months before implant. LGE was calculated as percentage myocardium with pixel intensity ≥5 standard deviations higher than that of reference myocardium. Endpoints were adjudicated retrospectively by chart review.
Results: A total of 125 of 344 patients (36%) had none or minimal LGE, and 219 (64%) had significant LGE. Over a median follow-up of 61 months, 53 patients (24%) with significant LGE vs 10 (8%) with none or minimal LGE met the primary endpoint, and 56 patients (26%) vs 21 (17%) met the secondary endpoint, respectively. Significant LGE predicted the primary outcome in multivariable competing-risks regression (hazard ratio [HR] 2.99, 95% confidence interval [CI] 1.48-6.02, P = .002), but did not predict the secondary outcome in multivariable Cox regression (HR 1.34, 95% CI 0.78-2.29, P = .287).
Conclusion: In patients with NICM and primary prevention ICDs, LGE ≥2% is predictive of appropriate device therapies but not all-cause mortality/LVAD/transplant. LGE may be a relatively specific predictor of sudden cardiac arrest risk and therefore could potentially be used during evaluation for prophylactic ICD implantation.
期刊介绍：
HeartRhythm, the official Journal of the Heart Rhythm Society and the Cardiac Electrophysiology Society, is a unique journal for fundamental discovery and clinical applicability.
HeartRhythm integrates the entire cardiac electrophysiology (EP) community from basic and clinical academic researchers, private practitioners, engineers, allied professionals, industry, and trainees, all of whom are vital and interdependent members of our EP community.
The Heart Rhythm Society is the international leader in science, education, and advocacy for cardiac arrhythmia professionals and patients, and the primary information resource on heart rhythm disorders. Its mission is to improve the care of patients by promoting research, education, and optimal health care policies and standards.
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