Scar characterization to predict life-threatening arrhythmic events and sudden cardiac death in patients with cardiac resynchronization therapy: ehe GAUDI-CRT Study

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• dc.contributor.author Acosta, Juan Carlosca
• dc.contributor.author Martí Almor, Julioca
• dc.contributor.author Berruezo Sánchez, Antonioca
• dc.date.accessioned 2018-06-07T07:53:32Z
• dc.date.issued 2018
• dc.description.abstract OBJECTIVES: The aim of this study was to analyze whether scar characterization could improve the risk stratification for life-threatening ventricular arrhythmias and sudden cardiac death (SCD). BACKGROUND: Among patients with a cardiac resynchronization therapy (CRT) indication, appropriate defibrillator (CRT-D) therapy rates are low. METHODS: Primary prevention patients with a class I indication for CRT were prospectively enrolled and assigned to CRT-D or CRT pacemaker according to physician's criteria. Pre-procedure contrast-enhanced cardiac magnetic resonance was obtained and analyzed to identify scar presence or absence, quantify the amount of core and border zone (BZ), and depict BZ distribution. The presence, mass, and characteristics of BZ channels in the scar were recorded. The primary endpoint was appropriate defibrillator therapy or SCD. RESULTS: 217 patients (39.6% ischemic) were included. During a median follow-up of 35.5 months (12 to 62 months), the primary endpoint occurred in 25 patients (11.5%) and did not occur in patients without myocardial scar. Among patients with scar (n = 125, 57.6%), those with implantable cardioverter-defibrillator (ICD) therapies or SCD exhibited greater scar mass (38.7 ± 34.2 g vs. 17.9 ± 17.2 g; p < 0.001), scar heterogeneity (BZ mass/scar mass ratio) (49.5 ± 13.0 vs. 40.1 ± 21.7; p = 0.044), and BZ channel mass (3.6 ± 3.0 g vs. 1.8 ± 3.4 g; p = 0.018). BZ mass (hazard ratio: 1.06 [95% confidence interval: 1.04 to 1.08]; p < 0.001) and BZ channel mass (hazard ratio: 1.21 [95% confidence interval: 1.10 to 1.32]; p < 0.001) were the strongest predictors of the primary endpoint. An algorithm based on scar mass and the absence of BZ channels identified 148 patients (68.2%) without ICD therapy/SCD during follow-up with a 100% negative predictive value. CONCLUSIONS: The presence, extension, heterogeneity, and qualitative distribution of BZ tissue of myocardial scar independently predict appropriate ICD therapies and SCD in CRT patients
• dc.format.mimetype application/pdf
• dc.identifier.citation Acosta J, Fernández-Armenta J, Borràs R, Anguera I, Bisbal F, Martí-Almor J. et al. Scar Characterization to Predict Life-Threatening Arrhythmic Events and Sudden Cardiac Death in Patients With Cardiac Resynchronization Therapy: The GAUDI-CRT Study. JACC Cardiovasc Imaging. 2018 Apr;11(4):561-572.DOI: 10.1016/j.jcmg.2017.04.021
• dc.identifier.doi http://dx.doi.org/10.1016/j.jcmg.2017.04.021
• dc.identifier.issn 1876-7591
• dc.identifier.uri http://hdl.handle.net/10230/34847
• dc.language.iso eng
• dc.publisher Elsevierca
• dc.relation.ispartof JACC: Cardiovascular Imaging. 2018 Apr;11(4):561-72
• dc.rights © Elsevier http://dx.doi.org/10.1016/j.jcmg.2017.04.021
• dc.rights.accessRights info:eu-repo/semantics/openAccess
• dc.subject.keyword Cardiac resynchronization therapy
• dc.subject.keyword Magnetic resonance imaging
• dc.subject.keyword Sudden cardiac death
• dc.subject.keyword Ventricular arrhythmias
• dc.subject.other Ressonància magnètica
• dc.subject.other Arítmia -- Tractament
• dc.subject.other Mort sobtada
• dc.title Scar characterization to predict life-threatening arrhythmic events and sudden cardiac death in patients with cardiac resynchronization therapy: ehe GAUDI-CRT Studyca
• dc.type info:eu-repo/semantics/article
• dc.type.version info:eu-repo/semantics/acceptedVersion