CARDIAC MRI PREDICTORS IN A "MADIT-II-LIKE" POPULATION

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This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. The Multicenter Automatic Defibrillator Implantation Trial II (MADIT-II) has shown benefit for Implantible Cardioverter Defibrillator (ICD) implantation without invasive testing. However, the number needed to treat using this criterion is two-fold higher that the previous criteria that required invasive testing prior to ICD implantation. We would like to find non-invasive means for determining who would benefit from an ICD. This study will test the hypothesis that the characteristics on cardiac MRI determines the subgroup of patients that qualify for ICD implantation but will not receive future shocks. Fifty-eight patients who are scheduled for ICD implantation at Northwestern Memorial Hospital who meet MADIT-II criteria (EF 30%, prior MI). They will have viability cardiac MRI images acquired, as well as holter, signal averaged ECG, t-wave alternans, and ECGs prior to device implantation. These patients will then be followed over one year, and the time to the first appropriate ICD firing will be recorded. All patients will be segregated into two groups based on the viability MRI infarct surface area. We will then perform a Kaplan-Meier analysis of time to first defibrillation over the first year for both groups, as well as a multivariate analysis on the remaining measured variables to look for other significant non-invasive measures that can predict shock such as t-wave alternans.