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The study was carried out with Beth Israel Deaconess Medical Center Institutional Review Board approval which waived written informed consent.
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Patient demographics and clinical follow-up records from the hospital electronic medical records were reviewed. Ischemic etiology was defined as the presence of any epicardial coronary artery dimeter stenosis >70%, a history of myocardial infarction, or a subendocardial based LGE pattern. Exclusion criteria were: 1) idiopathic outflow tract ventricular tachycardias, 2) Brugada, and Long QT syndromes, 3) hypertrophic, inflammatory, infiltrative, and arrhythmogenic cardiomyopathies. Subjects were identified by querying the Beth Israel Deaconess Medical Center clinical CMR and ICD databases from April 2004 to December 2014. We retrospectively identified 71 consecutive patients who had undergone ICD implantation for primary SCD prevention who had a comprehensive CMR study before ICD implantation. Accordingly, the purpose of this study was to evaluate whether easily derived LV geometry metrics provide additive predictive value for the prediction of future VA in patients with reduced LVEF receiving primary prevention ICD therapy. However, no data are currently available regarding the association between CMR-derived LV geometric parameters and VA risk. Cine CMR is accurate, reproducible, and widely considered the non-invasive gold standard for morphological and functional assessment of the LV. Although most CMR studies give the highest priority to the assessment of LGE scar tissue characteristics, 2D transthoracic echocardiographic adverse LV remodeling, as well as LV relative wall thickness are also associated with VA. Heterogeneous LGE scar but not LGE volume is predictive for VA, but reproducible measurement of heterogeneous LGE scar is difficult. Late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR) is the gold standard for the assessment of regional myocardial fibrosis and may help predict VA and sudden cardiac death (SCD). If ICD therapy is to be used in a more cost-effective and lower morbidity manner, identifications of variables more predictive of appropriate ICD therapy are needed. Current guidelines for primary prevention ICD includes symptoms of heart failure and reduced left ventricular (LV) ejection fraction (LVEF), but only a small percentage of primary prevention ICD recipients actually receive appropriate ICD therapy resulting in increasing societal costs and patient morbidity.
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The implanted cardioverter-defibrillator (ICD) is an established therapy for reducing mortality in patients with life-threating ventricular arrhythmia (VA).
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The combined assessment of LV geometry, mass index and systolic function may provide incremental prognostic information regarding ventricular arrhythmia requiring appropriate ICD therapy in primary prevention patients with reduced LVEF. When sphericity index, LVEF and mass index were used in combination, important incremental prognostic information was achieved (net reclassification improvement, 0.42 95% CI, 0.06 to 0.77). In addition, dichotomized volumetric CMR-derived sphericity index ≥0.57 carried a 4-fold hazard risk for appropriate ICD therapy, controlling for age and LVEF (HR, 4.49 95% CI, 1.53 to 13.21 p = 0.006). Multivariable Cox’s proportional hazard modeling identified increased CMR-derived sphericity index as the strongest independent predictor of appropriate ICD therapy (hazard ratio, 1.09 95% confidence interval, 1.02 to 1.16 p = 0.007). Resultsĭuring a median follow-up of 55 months (interquartile range 28–88), 15 patients (22%) received appropriate ICD therapy. Sphericity index was measured as the ratio of LV end-diastolic volume (from cine short axis stack) to the volume of a sphere with a LV end-diastolic 4-chamber length diameter. Sixty-eight consecutive patients with transthoracic echocardiographic LVEF <35% referred for CMR prior to ICD implantation for primary prevention of sudden death were identified. We sought to determine whether volumetric cardiovascular magnetic resonance (CMR) left ventricular (LV) spherical remodeling predicts future ventricular arrhythmias in primary ICD patients with reduced LV ejection fraction (EF). Most patients with implantable cardioverter-defibrillator (ICD) implantation fail to utilize the device resulting in increasing societal costs and patient exposure to device morbidity.