Scar Characterization to Predict Life-Threatening Arrhythmic Events and Sudden Cardiac Death in Patients With Cardiac Resynchronization Therapy The GAUDI-CRT Study
Por:
Acosta, J, Fernandez-Armenta, J, Borras, R, Anguera, I, Bisbal, F, Marti-Almor, J, Tolosana, JM, Penela, D, Andreu, D, Soto-Iglesias, D, Evertz, R, Matiello, M, Alonso, C, Villuendas, R, de Caralt, TM, Perea, RJ, Ortiz, JT, Bosch, X, Serra, L, Planes, X, Greiser, A, Ekinci, O, Lasalvia, L, Mont, L, Berruezo, A
Publicada:
1 abr 2018
Resumen:
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.
Filiaciones:
Acosta, J:
Univ Barcelona, Hosp Clin, Thorax Inst, Arrhythmia Sect,Cardiol Dept, Barcelona, Catalonia, Spain
Univ Barcelona, IDIBAPS, Inst Invest Agusti Pi & Sunyer, Barcelona, Catalonia, Spain
Inst Salud Carlos III, CIBERCV, Madrid, Spain
Fernandez-Armenta, J:
Univ Barcelona, Hosp Clin, Thorax Inst, Arrhythmia Sect,Cardiol Dept, Barcelona, Catalonia, Spain
Univ Barcelona, IDIBAPS, Inst Invest Agusti Pi & Sunyer, Barcelona, Catalonia, Spain
Inst Salud Carlos III, CIBERCV, Madrid, Spain
Borras, R:
Univ Barcelona, Hosp Clin, Thorax Inst, Arrhythmia Sect,Cardiol Dept, Barcelona, Catalonia, Spain
Univ Barcelona, IDIBAPS, Inst Invest Agusti Pi & Sunyer, Barcelona, Catalonia, Spain
Inst Salud Carlos III, CIBERCV, Madrid, Spain
Anguera, I:
Univ Barcelona, Bellvitge Hosp, Bellvitge Biomed Res Inst IDIBELL, Cardiol Dept,Heart Dis Inst, Barcelona, Spain
Bisbal, F:
Univ Barcelona, IDIBAPS, Inst Invest Agusti Pi & Sunyer, Barcelona, Catalonia, Spain
Inst Salud Carlos III, CIBERCV, Madrid, Spain
Univ Hosp Germans Trias & Pujol, Heart Inst iCor, Barcelona, Spain
Marti-Almor, J:
Univ Autonoma Barcelona, Hosp del Mar, Dept Med, Electrophysiol Unit,Cardiovasc Div, Barcelona, Spain
Tolosana, JM:
Univ Barcelona, Hosp Clin, Thorax Inst, Arrhythmia Sect,Cardiol Dept, Barcelona, Catalonia, Spain
Univ Barcelona, IDIBAPS, Inst Invest Agusti Pi & Sunyer, Barcelona, Catalonia, Spain
Inst Salud Carlos III, CIBERCV, Madrid, Spain
Penela, D:
Univ Barcelona, Hosp Clin, Thorax Inst, Arrhythmia Sect,Cardiol Dept, Barcelona, Catalonia, Spain
Univ Barcelona, IDIBAPS, Inst Invest Agusti Pi & Sunyer, Barcelona, Catalonia, Spain
Inst Salud Carlos III, CIBERCV, Madrid, Spain
Andreu, D:
Univ Barcelona, Hosp Clin, Thorax Inst, Arrhythmia Sect,Cardiol Dept, Barcelona, Catalonia, Spain
Univ Barcelona, IDIBAPS, Inst Invest Agusti Pi & Sunyer, Barcelona, Catalonia, Spain
Inst Salud Carlos III, CIBERCV, Madrid, Spain
Soto-Iglesias, D:
Univ Barcelona, Hosp Clin, Thorax Inst, Arrhythmia Sect,Cardiol Dept, Barcelona, Catalonia, Spain
Univ Barcelona, IDIBAPS, Inst Invest Agusti Pi & Sunyer, Barcelona, Catalonia, Spain
Inst Salud Carlos III, CIBERCV, Madrid, Spain
Evertz, R:
Univ Barcelona, Hosp Clin, Thorax Inst, Arrhythmia Sect,Cardiol Dept, Barcelona, Catalonia, Spain
Univ Barcelona, IDIBAPS, Inst Invest Agusti Pi & Sunyer, Barcelona, Catalonia, Spain
Inst Salud Carlos III, CIBERCV, Madrid, Spain
Matiello, M:
Catalonia Gen Hosp, Cardiol Dept, Arrhythmia Sect, Barcelona, Spain
Alonso, C:
Hosp Sta Creu & St Pau, Cardiol Dept, Arrhythmia Sect, Barcelona, Spain
Villuendas, R:
Univ Barcelona, IDIBAPS, Inst Invest Agusti Pi & Sunyer, Barcelona, Catalonia, Spain
Inst Salud Carlos III, CIBERCV, Madrid, Spain
Univ Hosp Germans Trias & Pujol, Heart Inst iCor, Barcelona, Spain
de Caralt, TM:
Univ Barcelona, Hosp Clin, Radiol Dept, Barcelona, Catalonia, Spain
Perea, RJ:
Univ Barcelona, Hosp Clin, Radiol Dept, Barcelona, Catalonia, Spain
Ortiz, JT:
Univ Barcelona, Hosp Clin, Thorax Inst, Arrhythmia Sect,Cardiol Dept, Barcelona, Catalonia, Spain
Univ Barcelona, IDIBAPS, Inst Invest Agusti Pi & Sunyer, Barcelona, Catalonia, Spain
Inst Salud Carlos III, CIBERCV, Madrid, Spain
Bosch, X:
Univ Barcelona, Hosp Clin, Thorax Inst, Arrhythmia Sect,Cardiol Dept, Barcelona, Catalonia, Spain
Univ Barcelona, IDIBAPS, Inst Invest Agusti Pi & Sunyer, Barcelona, Catalonia, Spain
Inst Salud Carlos III, CIBERCV, Madrid, Spain
Serra, L:
Galgo Med SL, Barcelona, Spain
Planes, X:
Galgo Med SL, Barcelona, Spain
Greiser, A:
Siemens Healthcare GmbH, Erlangen, Germany
Ekinci, O:
Siemens Healthineers, Chief Med Off, Erlangen, Germany
Univ Coll Dublin, Sch Med, Dublin, Ireland
Lasalvia, L:
Siemens Healthineers, Global Clin Mkt, Siemens Med Solut, New York, NY USA
Mont, L:
Univ Barcelona, Hosp Clin, Thorax Inst, Arrhythmia Sect,Cardiol Dept, Barcelona, Catalonia, Spain
Univ Barcelona, IDIBAPS, Inst Invest Agusti Pi & Sunyer, Barcelona, Catalonia, Spain
Inst Salud Carlos III, CIBERCV, Madrid, Spain
Berruezo, A:
Univ Barcelona, Hosp Clin, Thorax Inst, Arrhythmia Sect,Cardiol Dept, Barcelona, Catalonia, Spain
Univ Barcelona, IDIBAPS, Inst Invest Agusti Pi & Sunyer, Barcelona, Catalonia, Spain
Inst Salud Carlos III, CIBERCV, Madrid, Spain
Bronze, Green Accepted
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