Associations between scar characteristics by cardiac magnetic resonance and changes in left ventricular ejection fraction in primary prevention defibrillator recipients

Yiyi Zhang, Eliseo Guallar, Robert George Weiss, Michael Stillabower, Gary Gerstenblith, Gordon F. Tomaselli, Katherine Chih-Ching Wu

Research output: Contribution to journalArticle

Abstract

Background: Left ventricular ejection fraction (LVEF) improves over time in 25%-40% of patients with cardiomyopathy with primary prevention implantable cardioverter-defibrillator (ICD). The determinants of LVEF improvement, however, are not well characterized. Objectives: We sought to examine the associations of clinical risk factors and cardiac imaging markers with changes in LVEF after ICD implantation. Methods: We conducted a retrospective analysis of cardiac magnetic resonance images in 202 patients who underwent primary prevention ICD implantation to quantify the amount of heterogeneous myocardial tissue (gray zone), dense core, and total scar. LVEF was reassessed at least once after ICD implantation. Results: Over a mean follow-up of 3 years, LVEF decreased in 43 (21.3%), improved in 88 (43.6%), and was unchanged in 71 (35.1%) of the patients. Baseline LVEF and myocardial scar characteristics were the strongest determinants of LVEF trajectory with high scar burden and increasing lack of myocardial viability associated with a greater decline in LVEF. There was a trend toward an association between both changes in LVEF and scar extent with subsequent appropriate ICD shock. Changes in LVEF were also strongly associated with heart failure hospitalizations. Conclusion: Scar burden and characteristics were strong determinants, independent of baseline LVEF and other traditional cardiovascular risk factors, of changes in LVEF. Both worsened LVEF and high scar extent were associated with a trend toward increased risk of appropriate shock. These findings suggest that baseline cardiac magnetic resonance imaging of the myocardial substrate may provide important prognostic information on subsequent left ventricular remodeling and adverse events.

Original languageEnglish (US)
JournalHeart Rhythm
DOIs
StateAccepted/In press - 2016

Fingerprint

Defibrillators
Primary Prevention
Stroke Volume
Cicatrix
Magnetic Resonance Spectroscopy
Implantable Defibrillators
Shock
Ventricular Remodeling
Cardiomyopathies
Hospitalization

Keywords

  • Appropriate shock
  • Cardiac magnetic resonance
  • Ejection fraction
  • Gray zone
  • Implantable cardioverter-defibrillator
  • Myocardial scar

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

@article{a93cd8110649470ba79325deac4da70f,
title = "Associations between scar characteristics by cardiac magnetic resonance and changes in left ventricular ejection fraction in primary prevention defibrillator recipients",
abstract = "Background: Left ventricular ejection fraction (LVEF) improves over time in 25{\%}-40{\%} of patients with cardiomyopathy with primary prevention implantable cardioverter-defibrillator (ICD). The determinants of LVEF improvement, however, are not well characterized. Objectives: We sought to examine the associations of clinical risk factors and cardiac imaging markers with changes in LVEF after ICD implantation. Methods: We conducted a retrospective analysis of cardiac magnetic resonance images in 202 patients who underwent primary prevention ICD implantation to quantify the amount of heterogeneous myocardial tissue (gray zone), dense core, and total scar. LVEF was reassessed at least once after ICD implantation. Results: Over a mean follow-up of 3 years, LVEF decreased in 43 (21.3{\%}), improved in 88 (43.6{\%}), and was unchanged in 71 (35.1{\%}) of the patients. Baseline LVEF and myocardial scar characteristics were the strongest determinants of LVEF trajectory with high scar burden and increasing lack of myocardial viability associated with a greater decline in LVEF. There was a trend toward an association between both changes in LVEF and scar extent with subsequent appropriate ICD shock. Changes in LVEF were also strongly associated with heart failure hospitalizations. Conclusion: Scar burden and characteristics were strong determinants, independent of baseline LVEF and other traditional cardiovascular risk factors, of changes in LVEF. Both worsened LVEF and high scar extent were associated with a trend toward increased risk of appropriate shock. These findings suggest that baseline cardiac magnetic resonance imaging of the myocardial substrate may provide important prognostic information on subsequent left ventricular remodeling and adverse events.",
keywords = "Appropriate shock, Cardiac magnetic resonance, Ejection fraction, Gray zone, Implantable cardioverter-defibrillator, Myocardial scar",
author = "Yiyi Zhang and Eliseo Guallar and Weiss, {Robert George} and Michael Stillabower and Gary Gerstenblith and Tomaselli, {Gordon F.} and Wu, {Katherine Chih-Ching}",
year = "2016",
doi = "10.1016/j.hrthm.2016.04.013",
language = "English (US)",
journal = "Heart Rhythm",
issn = "1547-5271",
publisher = "Elsevier",

}

TY - JOUR

T1 - Associations between scar characteristics by cardiac magnetic resonance and changes in left ventricular ejection fraction in primary prevention defibrillator recipients

AU - Zhang, Yiyi

AU - Guallar, Eliseo

AU - Weiss, Robert George

AU - Stillabower, Michael

AU - Gerstenblith, Gary

AU - Tomaselli, Gordon F.

AU - Wu, Katherine Chih-Ching

PY - 2016

Y1 - 2016

N2 - Background: Left ventricular ejection fraction (LVEF) improves over time in 25%-40% of patients with cardiomyopathy with primary prevention implantable cardioverter-defibrillator (ICD). The determinants of LVEF improvement, however, are not well characterized. Objectives: We sought to examine the associations of clinical risk factors and cardiac imaging markers with changes in LVEF after ICD implantation. Methods: We conducted a retrospective analysis of cardiac magnetic resonance images in 202 patients who underwent primary prevention ICD implantation to quantify the amount of heterogeneous myocardial tissue (gray zone), dense core, and total scar. LVEF was reassessed at least once after ICD implantation. Results: Over a mean follow-up of 3 years, LVEF decreased in 43 (21.3%), improved in 88 (43.6%), and was unchanged in 71 (35.1%) of the patients. Baseline LVEF and myocardial scar characteristics were the strongest determinants of LVEF trajectory with high scar burden and increasing lack of myocardial viability associated with a greater decline in LVEF. There was a trend toward an association between both changes in LVEF and scar extent with subsequent appropriate ICD shock. Changes in LVEF were also strongly associated with heart failure hospitalizations. Conclusion: Scar burden and characteristics were strong determinants, independent of baseline LVEF and other traditional cardiovascular risk factors, of changes in LVEF. Both worsened LVEF and high scar extent were associated with a trend toward increased risk of appropriate shock. These findings suggest that baseline cardiac magnetic resonance imaging of the myocardial substrate may provide important prognostic information on subsequent left ventricular remodeling and adverse events.

AB - Background: Left ventricular ejection fraction (LVEF) improves over time in 25%-40% of patients with cardiomyopathy with primary prevention implantable cardioverter-defibrillator (ICD). The determinants of LVEF improvement, however, are not well characterized. Objectives: We sought to examine the associations of clinical risk factors and cardiac imaging markers with changes in LVEF after ICD implantation. Methods: We conducted a retrospective analysis of cardiac magnetic resonance images in 202 patients who underwent primary prevention ICD implantation to quantify the amount of heterogeneous myocardial tissue (gray zone), dense core, and total scar. LVEF was reassessed at least once after ICD implantation. Results: Over a mean follow-up of 3 years, LVEF decreased in 43 (21.3%), improved in 88 (43.6%), and was unchanged in 71 (35.1%) of the patients. Baseline LVEF and myocardial scar characteristics were the strongest determinants of LVEF trajectory with high scar burden and increasing lack of myocardial viability associated with a greater decline in LVEF. There was a trend toward an association between both changes in LVEF and scar extent with subsequent appropriate ICD shock. Changes in LVEF were also strongly associated with heart failure hospitalizations. Conclusion: Scar burden and characteristics were strong determinants, independent of baseline LVEF and other traditional cardiovascular risk factors, of changes in LVEF. Both worsened LVEF and high scar extent were associated with a trend toward increased risk of appropriate shock. These findings suggest that baseline cardiac magnetic resonance imaging of the myocardial substrate may provide important prognostic information on subsequent left ventricular remodeling and adverse events.

KW - Appropriate shock

KW - Cardiac magnetic resonance

KW - Ejection fraction

KW - Gray zone

KW - Implantable cardioverter-defibrillator

KW - Myocardial scar

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