Combined cardiac magnetic resonance imaging and C-reactive protein levels identify a cohort at low risk for defibrillator firings and death

Katherine Chih-Ching Wu, Gary Gerstenblith, Eliseo Guallar, Joseph Marine, Darshan Dalal, Alan Cheng, Eduardo Marbán, Joao Lima, Gordon F. Tomaselli, Robert George Weiss

Research output: Contribution to journalArticle

Abstract

Background-Annually, ≈80 000 Americans receive guideline-based primary prevention implantable cardioverterdefibrillators (ICDs), but appropriate firing rates are low. Current selection criteria for ICDs rely on left ventricular ejection fraction, which lacks sensitivity and specificity. Because scar-related myocardial tissue heterogeneity is a substrate for life-threatening arrhythmias, we hypothesized that cardiac magnetic resonance identification of myocardial heterogeneity improves risk stratification through (1) its association with adverse cardiac events independent of clinical factors and biomarker levels and (2) its ability to identify particularly high-and low-risk subgroups. Methods and Results-In 235 patients with chronic ischemic and nonischemic cardiomyopathy with a left ventricular ejection fraction of ≤35% undergoing clinically indicated primary prevention ICD implantation, gadolinium-enhanced cardiac magnetic resonance was prospectively performed to quantify the amount of heterogeneous myocardial tissue (gray zone [GZ]) and dense core scar. Serum high-sensitivity C-reactive protein (hsCRP) and other biomarkers were assayed. The primary end point was appropriate ICD shock for ventricular tachycardia/fibrillation or cardiac death, which occurred in 45 (19%) patients at a 3.6-year median follow-up. On univariable analysis, only diuretics, hsCRP, GZ, and core scar were associated with outcome. After multivariable adjustment, GZ and hsCRP remained independently associated with outcome (P

Original languageEnglish (US)
Pages (from-to)178-186
Number of pages9
JournalCirculation: Cardiovascular Imaging
Volume5
Issue number2
DOIs
StatePublished - Mar 2012

Fingerprint

Defibrillators
C-Reactive Protein
Cicatrix
Magnetic Resonance Imaging
Primary Prevention
Stroke Volume
Magnetic Resonance Spectroscopy
Biomarkers
Gadolinium
Ventricular Fibrillation
Ventricular Tachycardia
Cardiomyopathies
Diuretics
Patient Selection
Cardiac Arrhythmias
Shock
Guidelines
Sensitivity and Specificity
Serum

Keywords

  • Arrhythmia
  • Cardiomyopathy
  • Implantable cardioverter-defibrillators
  • Magnetic resonance imaging
  • Myocardial ischemia

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Radiology Nuclear Medicine and imaging
  • Medicine(all)

Cite this

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title = "Combined cardiac magnetic resonance imaging and C-reactive protein levels identify a cohort at low risk for defibrillator firings and death",
abstract = "Background-Annually, ≈80 000 Americans receive guideline-based primary prevention implantable cardioverterdefibrillators (ICDs), but appropriate firing rates are low. Current selection criteria for ICDs rely on left ventricular ejection fraction, which lacks sensitivity and specificity. Because scar-related myocardial tissue heterogeneity is a substrate for life-threatening arrhythmias, we hypothesized that cardiac magnetic resonance identification of myocardial heterogeneity improves risk stratification through (1) its association with adverse cardiac events independent of clinical factors and biomarker levels and (2) its ability to identify particularly high-and low-risk subgroups. Methods and Results-In 235 patients with chronic ischemic and nonischemic cardiomyopathy with a left ventricular ejection fraction of ≤35{\%} undergoing clinically indicated primary prevention ICD implantation, gadolinium-enhanced cardiac magnetic resonance was prospectively performed to quantify the amount of heterogeneous myocardial tissue (gray zone [GZ]) and dense core scar. Serum high-sensitivity C-reactive protein (hsCRP) and other biomarkers were assayed. The primary end point was appropriate ICD shock for ventricular tachycardia/fibrillation or cardiac death, which occurred in 45 (19{\%}) patients at a 3.6-year median follow-up. On univariable analysis, only diuretics, hsCRP, GZ, and core scar were associated with outcome. After multivariable adjustment, GZ and hsCRP remained independently associated with outcome (P",
keywords = "Arrhythmia, Cardiomyopathy, Implantable cardioverter-defibrillators, Magnetic resonance imaging, Myocardial ischemia",
author = "Wu, {Katherine Chih-Ching} and Gary Gerstenblith and Eliseo Guallar and Joseph Marine and Darshan Dalal and Alan Cheng and Eduardo Marb{\'a}n and Joao Lima and Tomaselli, {Gordon F.} and Weiss, {Robert George}",
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T1 - Combined cardiac magnetic resonance imaging and C-reactive protein levels identify a cohort at low risk for defibrillator firings and death

AU - Wu, Katherine Chih-Ching

AU - Gerstenblith, Gary

AU - Guallar, Eliseo

AU - Marine, Joseph

AU - Dalal, Darshan

AU - Cheng, Alan

AU - Marbán, Eduardo

AU - Lima, Joao

AU - Tomaselli, Gordon F.

AU - Weiss, Robert George

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N2 - Background-Annually, ≈80 000 Americans receive guideline-based primary prevention implantable cardioverterdefibrillators (ICDs), but appropriate firing rates are low. Current selection criteria for ICDs rely on left ventricular ejection fraction, which lacks sensitivity and specificity. Because scar-related myocardial tissue heterogeneity is a substrate for life-threatening arrhythmias, we hypothesized that cardiac magnetic resonance identification of myocardial heterogeneity improves risk stratification through (1) its association with adverse cardiac events independent of clinical factors and biomarker levels and (2) its ability to identify particularly high-and low-risk subgroups. Methods and Results-In 235 patients with chronic ischemic and nonischemic cardiomyopathy with a left ventricular ejection fraction of ≤35% undergoing clinically indicated primary prevention ICD implantation, gadolinium-enhanced cardiac magnetic resonance was prospectively performed to quantify the amount of heterogeneous myocardial tissue (gray zone [GZ]) and dense core scar. Serum high-sensitivity C-reactive protein (hsCRP) and other biomarkers were assayed. The primary end point was appropriate ICD shock for ventricular tachycardia/fibrillation or cardiac death, which occurred in 45 (19%) patients at a 3.6-year median follow-up. On univariable analysis, only diuretics, hsCRP, GZ, and core scar were associated with outcome. After multivariable adjustment, GZ and hsCRP remained independently associated with outcome (P

AB - Background-Annually, ≈80 000 Americans receive guideline-based primary prevention implantable cardioverterdefibrillators (ICDs), but appropriate firing rates are low. Current selection criteria for ICDs rely on left ventricular ejection fraction, which lacks sensitivity and specificity. Because scar-related myocardial tissue heterogeneity is a substrate for life-threatening arrhythmias, we hypothesized that cardiac magnetic resonance identification of myocardial heterogeneity improves risk stratification through (1) its association with adverse cardiac events independent of clinical factors and biomarker levels and (2) its ability to identify particularly high-and low-risk subgroups. Methods and Results-In 235 patients with chronic ischemic and nonischemic cardiomyopathy with a left ventricular ejection fraction of ≤35% undergoing clinically indicated primary prevention ICD implantation, gadolinium-enhanced cardiac magnetic resonance was prospectively performed to quantify the amount of heterogeneous myocardial tissue (gray zone [GZ]) and dense core scar. Serum high-sensitivity C-reactive protein (hsCRP) and other biomarkers were assayed. The primary end point was appropriate ICD shock for ventricular tachycardia/fibrillation or cardiac death, which occurred in 45 (19%) patients at a 3.6-year median follow-up. On univariable analysis, only diuretics, hsCRP, GZ, and core scar were associated with outcome. After multivariable adjustment, GZ and hsCRP remained independently associated with outcome (P

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KW - Cardiomyopathy

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