Scar heterogeneity on cardiovascular magnetic resonance as a predictor of appropriate implantable cardioverter defibrillator therapy.
Scar heterogeneity on cardiovascular magnetic resonance as a predictor of appropriate implantable cardioverter defibrillator therapy.
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DOI：
10.1186/1532-429x-15-31
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发表时间：
2013-04-10
期刊：
影响因子：
--
通讯作者：
Nezafat R
中科院分区：
文献类型：
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作者：
Rayatzadeh H;Tan A;Chan RH;Patel SJ;Hauser TH;Ngo L;Shaw JL;Hong SN;Zimetbaum P;Buxton AE;Josephson ME;Manning WJ;Nezafat R
尽管植入式心脏复律除颤器(ICD)对生存有好处，但绝大多数接受ICD一级预防的患者没有接受ICD治疗。我们试图评估晚期Gd增强心血管磁共振(LGE-CMR)确定的不均匀疤痕面积(HSA)在预测初级预防心脏性猝死(SCD)的ICD治疗中的作用。从2003年9月至2011年3月，所有接受一级预防ICD植入并在植入前进行LGE-CMR的患者均被确定。瘢痕大小以远端正常心肌之上4和6个标准差(SD)为阈值，HSA用3种不同的标准定义，即介于2~4SD(HSA2~4SD)、2SD~6SD(HSA2~6SD)和4SD~6SD(HSA4~6SD)之间的区域。治疗的终点是适当的ICD治疗。40例患者随访25 ± 24个月，其中7例接受了适当的ICD治疗。ICD治疗组和非ICD治疗组不同阈值测量的瘢痕大小相似(均为P = NS)。而ICD组HSA2-4SD和HSA4-6SD显著高于对照组(P<0.001.0 5和P<0.0 3)。 = 分别为P<0.0 1和P<0.0 1。在多变量模型中，HSA2-4SD是ICD治疗的唯一有意义的独立预测因素(HR = 1.08，95%CI：1.00~1.16，P = 0.04)。Kaplan-Meier分析显示，HSA2-4SD较大的患者在未接受适当ICD治疗的情况下生存率较低(P = 0.026)。在一级预防ICD植入中，LGE-CMR HSA确定患者是否接受适当的ICD治疗。如果在更大的系列中得到证实，HSA可用于SCD一级预防的风险分层。
Despite the survival benefit of implantable-cardioverter-defibrillators (ICDs), the vast majority of patients receiving an ICD for primary prevention do not receive ICD therapy. We sought to assess the role of heterogeneous scar area (HSA) identified by late gadolinium enhancement cardiovascular magnetic resonance (LGE-CMR) in predicting appropriate ICD therapy for primary prevention of sudden cardiac death (SCD). From September 2003 to March 2011, all patients who underwent primary prevention ICD implantation and had a pre-implantation LGE-CMR were identified. Scar size was determined using thresholds of 4 and 6 standard deviations (SD) above remote normal myocardium; HSA was defined using 3 different criteria; as the region between 2 SD and 4 SD (HSA2-4SD), between 2SD and 6SD (HSA2-6SD), and between 4SD and 6SD (HSA4-6SD). The end-point was appropriate ICD therapy. Out of 40 total patients followed for 25 ± 24 months, 7 had appropriate ICD therapy. Scar size measured by different thresholds was similar in ICD therapy and non-ICD therapy groups (P = NS for all). However, HSA2-4SD and HSA4-6SD were significantly larger in the ICD therapy group (P = 0.001 and P = 0.03, respectively). In multivariable model HSA2-4SD was the only significant independent predictor of ICD therapy (HR = 1.08, 95%CI: 1.00-1.16, P = 0.04). Kaplan-Meier analysis showed that patients with greater HSA2-4SD had a lower survival free of appropriate ICD therapy (P = 0.026). In primary prevention ICD implantation, LGE-CMR HSA identifies patients with appropriate ICD therapy. If confirmed in larger series, HSA can be used for risk stratification in primary prevention of SCD.