Sudden cardiac death (SCD) is the most common cause of cardiovascular death averaging 300,000 deaths in the United States annually (1).
In most cases,
SCD is caused by ventricular tachycardia (VT) and ventricular fibrillation (2),
warranting effective prevention strategies of these cardiac rhythm abnormalities to lower the morality rate.
In the broad spectrum of cardiovascular diseases,
the most common underlying cause of SCD is coronary artery disease (CAD) (3).
In ischemic cardiomyopathy (ICM),
the presence and extension of scarring and interstitial fibrosis create the substrate...
Methods and Materials
The study population consisted of 515 consecutive patients with clinical history of chronic heart failure according to the Framingham Criteria (10) and referred to our hospital to be evaluated for ICD implantation in primary prevention between January 2011 and December 2013.
Exclusion criteria were unstable angina (n= 30),
decompensated heart failure (n= 28),
acute myocarditis (n= 3),
severe claustrophobia (n= 15),
presence of an implantable device (n= 11),
estimated glomerular filtration rate ≤30 ml/min (n= 12),
and contraindication to gadolinium contrast agent (n= 7).
Figure 1 shows the study flow diagram.
514 patients were screened and 105 were excluded according to the exclusion criteria.
409 patients were finally included in the study population.
Both imaging tests were performed successfully in all patients.
The mean follow-up was 738±381 days and was completed in all patients.
Patient baseline characteristics are listed in Figure 2.The univariate (Figure 3) and multivariate analysis (Figure 4) showed that CMR-LVEF≤35% and LGE were independently associated with MACE (p<0.01).For the composite end point,
This study confirms that TTE is limited by a systematic overestimation of LVEF and lack of information regarding to myocardial tissue characterization as compared to CMR in ICM and DCM patients.
This may impact clinical decision-making for ICD therapy suggesting that patient assessment with volumetric CMR-LVEF and LGE detection may be superior to TTE-LVEF for risk stratification.
CMR imaging may identify a subgroup of patients in which ICD implantation is still indicated despite a TTE-LVEF higher than 35%.
Sudden cardiac death: epidemiology and risk factors.
Nat Rev Cardiol 2010;4:216-25.
Kessler KM and Castellanos A.
Sudden cardiac death.
and time-dependence of risk.
Circulation 1992;85:Suppl-10 (mancano le pagine!).
Borggrefe M et al.
ACC/AHA/ESC 2006 Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: a report of the American College of Cardiology/American Heart Association Task Force and the European Society of...