MRI Assessment of Myocardial Deformation for Risk Stratification of Major Arrhythmic Events in Patients With Non-Ischemic Cardiomyopathy Eligible for Primary Prevention Implantable Cardioverter Defibrillators.

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  • Additional Information
    • Source:
      Publisher: Wiley-Liss Country of Publication: United States NLM ID: 9105850 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1522-2586 (Electronic) Linking ISSN: 10531807 NLM ISO Abbreviation: J Magn Reson Imaging Subsets: MEDLINE
    • Publication Information:
      Publication: <2005-> : Hoboken , N.J. : Wiley-Liss
      Original Publication: Chicago, IL : Society for Magnetic Resonance Imaging, c1991-
    • Subject Terms:
      Defibrillators, Implantable* ; Cardiomyopathies*/diagnostic imaging ; Primary Prevention* ; Magnetic Resonance Imaging*/methods; Humans ; Male ; Middle Aged ; Female ; Retrospective Studies ; Risk Assessment ; Prospective Studies ; Aged ; Prognosis ; Arrhythmias, Cardiac/diagnostic imaging ; Adult ; Myocardium/pathology ; Magnetic Resonance Imaging, Cine/methods ; Gadolinium
    • Abstract:
      Background: Implantable cardioverter-defibrillator (ICD) intervention is an established prophylactic measure. Identifying high-benefit patients poses challenges.
      Purpose: To assess the prognostic value of cardiac magnetic resonance imaging (MRI) parameters including myocardial deformation for risk stratification of ICD intervention in non-ischemic cardiomyopathy (NICM) while accounting for competing mortality risk.
      Study Type: Retrospective and prospective.
      Population: One hundred and fifty-nine NICM patients eligible for primary ICD (117 male, 54 ± 13 years) and 49 control subjects (38 male, 53 ± 5 years).
      Field Strength/sequence: Balanced steady state free precession (bSSFP) and three-dimensional phase-sensitive inversion-recovery late gadolinium enhancement (LGE) sequences at 1.5 T or 3 T.
      Assessment: Patients underwent MRI before ICD implantation and were followed up. Functional parameters, left ventricular global radial, circumferential and longitudinal strain, right ventricular free wall longitudinal strain (RV FWLS) and left atrial strain were measured (Circle, cvi42). LGE presence was assessed visually. The primary endpoint was appropriate ICD intervention. Models were developed to determine outcome, with and without accounting for competing risk (non-sudden cardiac death), and compared to a baseline model including LGE and clinical features.
      Statistical Tests: Wilcoxon non-parametric test, Cox's proportional hazards regression, Fine-Gray competing risk model, and cumulative incidence functions. Harrell's c statistic was used for model selection. A P value <0.05 was considered statistically significant.
      Results: Follow-up duration was 1176 ± 960 days (median: 896). Twenty-six patients (16%) met the primary endpoint. RV FWLS demonstrated a significant difference between patients with and without events (-12.5% ± 5 vs. -16.4% ± 5.5). Univariable analyses showed LGE and RV FWLS were significantly associated with outcome (LGE: hazard ratio [HR] = 3.69, 95% CI = 1.28-10.62; RV FWLS: HR = 2.04, 95% CI = 1.30-3.22). RV FWLS significantly improved the prognostic value of baseline model and remained significant in multivariable analysis, accounting for competing risk (HR = 1.73, 95% CI = 1.12-2.66).
      Data Conclusions: In NICM, RV FWLS may provide additional predictive value for predicting appropriate ICD intervention.
      Level of Evidence: 2 TECHNICAL EFFICACY: Stage 5.
      (© 2024 International Society for Magnetic Resonance in Medicine.)
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    • Grant Information:
      R01AG068141 United States GF NIH HHS; 1R01HL129185 United States GF NIH HHS; R01HL161697 United States GF NIH HHS; R01 HL161697 United States HL NHLBI NIH HHS; R01 AG068141 United States AG NIA NIH HHS; R21 HL127650 United States HL NHLBI NIH HHS; R01 HL129157 United States HL NHLBI NIH HHS; R01 HL129185 United States HL NHLBI NIH HHS; R01 HL127015 United States HL NHLBI NIH HHS; 1R01HL127015 United States GF NIH HHS; 1R01HL129157 United States GF NIH HHS
    • Contributed Indexing:
      Keywords: appropriate ICD intervention; myocardial strain; non‐ischemic cardiomyopathy; risk stratification of major arrhythmic events
    • Accession Number:
      AU0V1LM3JT (Gadolinium)
    • Publication Date:
      Date Created: 20240119 Date Completed: 20241010 Latest Revision: 20241012
    • Publication Date:
      20241012
    • Accession Number:
      PMC11258208
    • Accession Number:
      10.1002/jmri.29238
    • Accession Number:
      38240166