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Title: Scar Characterization to Predict Life-Threatening Arrhythmic Events and Sudden Cardiac Death in Patients With Cardiac Resynchronization Therapy The GAUDI-CRT Study
Author: Acosta, Juan
Fernández Armenta, Juan
Borras, Roger
Anguera Camós, Ignasi
Bisbal, Felipe
Martí Almor, Julio
Tolosana, José M. (José María)
Penela, Diego
Andreu, David
Soto Iglesias, David
Evertz, Reinder
Matiello, María
Alonso, Concepción
Villuendas, Roger
Caralt Robira, Ma. Teresa de
Perea, Rosario J.
Ortiz, Jose T.
Bosch José, Francesc Xavier, 1947-
Serra, Luis
Planes, Xavier
Greiser, Andreas
Ekinci, Okan
Lasalvia, Luis
Mont Girbau, Lluís
Berruezo, Antonio
Keywords: Arrítmia
Malalties del cor
Heart diseases
Issue Date: 1-Apr-2018
Publisher: Elsevier Science Inc
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. (c) 2018 by the American College of Cardiology Foundation.
Note: Versió postprint del document publicat a:
It is part of: Jacc-cardiovascular Imaging, 2018, vol. 11, num. 4, p. 561-572
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Appears in Collections:Articles publicats en revistes (Institut d'lnvestigació Biomèdica de Bellvitge (IDIBELL))
Articles publicats en revistes (IDIBAPS: Institut d'investigacions Biomèdiques August Pi i Sunyer)

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