INFARCT CHARACTERISTICS DETERMINED BY CARDIAC MRI PREDICTIVE OF ARRHYTHMIC EVENT

这个子项目是许多研究子项目中的一个 由NIH/NCRR资助的中心赠款提供的资源。子项目和 研究者（PI）可能从另一个NIH来源获得了主要资金， 因此可在其他CRISP条目中表示。所列机构为 研究中心，而研究中心不一定是研究者所在的机构。 多中心自动除颤器植入试验II（MADIT-II）显示了植入式心律转复除颤器（ICD）的受益，无需进行侵入性测试。 然而，使用该标准治疗所需的数量是之前ICD植入前需要侵入性测试的标准的两倍。 我们希望找到非侵入性方法来确定谁将从ICD中受益。 本研究将检验心脏MRI的特征确定有资格植入ICD但未来不会接受电击的患者亚组的假设。 计划在西北纪念医院植入ICD的58例患者符合MADIT-II标准（EF 30%，既往MI）。 在器械植入前，他们将获得存活心脏MRI图像，以及霍尔特、信号平均ECG、t波交替和ECG。 然后将对这些患者进行一年以上的随访，并记录至首次适当ICD击发的时间。 根据存活MRI梗死表面积将所有患者分为两组。 然后，我们将对两组在第一年内首次除颤的时间进行Kaplan-Meier分析，并对剩余的测量变量进行多变量分析，以寻找其他可以预测电击的重要非侵入性指标，如t波交替。

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.