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Cardiac Magnetic Resonance Scar Imaging for Sudden Cardiac Death Risk Stratification in Patients with Non-Ischemic Cardiomyopathy.

Kim EK, Chattranukulchai P, Klem I - Korean J Radiol (2015)

Bottom Line: In patients with non-ischemic cardiomyopathy (NICM), risk stratification for sudden cardiac death (SCD) and selection of patients who would benefit from prophylactic implantable cardioverter-defibrillators remains challenging.We aim to discuss the evidence of cardiac magnetic resonance (CMR)-derived myocardial scar for the prediction of adverse cardiovascular outcomes in NICM.In patients with myocardial scar, the risk for adverse cardiac events was more than 3-fold higher, and risk for arrhythmic events 5-fold higher, as compared to patients without scar.

View Article: PubMed Central - PubMed

Affiliation: Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710, Korea.

ABSTRACT
In patients with non-ischemic cardiomyopathy (NICM), risk stratification for sudden cardiac death (SCD) and selection of patients who would benefit from prophylactic implantable cardioverter-defibrillators remains challenging. We aim to discuss the evidence of cardiac magnetic resonance (CMR)-derived myocardial scar for the prediction of adverse cardiovascular outcomes in NICM. From the 15 studies analyzed, with a total of 2747 patients, the average prevalence of myocardial scar was 41%. In patients with myocardial scar, the risk for adverse cardiac events was more than 3-fold higher, and risk for arrhythmic events 5-fold higher, as compared to patients without scar. Based on the available observational, single center studies, CMR scar assessment may be a promising new tool for SCD risk stratification, which merits further investigation.

No MeSH data available.


Related in: MedlinePlus

Individual and pooled hazard ratios from univariate Cox proportional hazards analysis for risk of major cardiovascular events.Forest plot comparing prognosis of NICM patients with and without scar, detected by delayed-enhancement CMR. CI = confidence interval, MACE = major adverse cardiovascular event, NICM = non-ischemic cardiomyopathy
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Figure 2: Individual and pooled hazard ratios from univariate Cox proportional hazards analysis for risk of major cardiovascular events.Forest plot comparing prognosis of NICM patients with and without scar, detected by delayed-enhancement CMR. CI = confidence interval, MACE = major adverse cardiovascular event, NICM = non-ischemic cardiomyopathy

Mentions: Figure 2 summarizes the univariate associations of the presence of myocardial scar to the primary study endpoints, which are heterogeneous in the 13 studies analyzed (see Table 2 for list of primary endpoints), and therefore summarized as major adverse cardiac events (MACE). Overall, patients with myocardial scar had a more than 3-fold higher risk for MACE compared with patients without scar (hazard ratio [HR], 3.40; 95% confidence interval, 2.47-4.69). Two studies were not included in this analysis. Wu et al. (45) focused on the prognostic role of "grey-zone" of intermediate signal intensity scar, and provide limited data on total scar. The authors presented total scar data only stratified in tertiles, wherein the tertile with largest scar extent has a higher event risk compared to the lowest tertile (HR, 3.4; 95% confidence interval, 1.6-7.0). Iles et al. (46) demonstrated that NICM patients with scar have a higher event risk than NICM patients without a scar and a group of patients with ICM; however, they did not provide a HR.


Cardiac Magnetic Resonance Scar Imaging for Sudden Cardiac Death Risk Stratification in Patients with Non-Ischemic Cardiomyopathy.

Kim EK, Chattranukulchai P, Klem I - Korean J Radiol (2015)

Individual and pooled hazard ratios from univariate Cox proportional hazards analysis for risk of major cardiovascular events.Forest plot comparing prognosis of NICM patients with and without scar, detected by delayed-enhancement CMR. CI = confidence interval, MACE = major adverse cardiovascular event, NICM = non-ischemic cardiomyopathy
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4499533&req=5

Figure 2: Individual and pooled hazard ratios from univariate Cox proportional hazards analysis for risk of major cardiovascular events.Forest plot comparing prognosis of NICM patients with and without scar, detected by delayed-enhancement CMR. CI = confidence interval, MACE = major adverse cardiovascular event, NICM = non-ischemic cardiomyopathy
Mentions: Figure 2 summarizes the univariate associations of the presence of myocardial scar to the primary study endpoints, which are heterogeneous in the 13 studies analyzed (see Table 2 for list of primary endpoints), and therefore summarized as major adverse cardiac events (MACE). Overall, patients with myocardial scar had a more than 3-fold higher risk for MACE compared with patients without scar (hazard ratio [HR], 3.40; 95% confidence interval, 2.47-4.69). Two studies were not included in this analysis. Wu et al. (45) focused on the prognostic role of "grey-zone" of intermediate signal intensity scar, and provide limited data on total scar. The authors presented total scar data only stratified in tertiles, wherein the tertile with largest scar extent has a higher event risk compared to the lowest tertile (HR, 3.4; 95% confidence interval, 1.6-7.0). Iles et al. (46) demonstrated that NICM patients with scar have a higher event risk than NICM patients without a scar and a group of patients with ICM; however, they did not provide a HR.

Bottom Line: In patients with non-ischemic cardiomyopathy (NICM), risk stratification for sudden cardiac death (SCD) and selection of patients who would benefit from prophylactic implantable cardioverter-defibrillators remains challenging.We aim to discuss the evidence of cardiac magnetic resonance (CMR)-derived myocardial scar for the prediction of adverse cardiovascular outcomes in NICM.In patients with myocardial scar, the risk for adverse cardiac events was more than 3-fold higher, and risk for arrhythmic events 5-fold higher, as compared to patients without scar.

View Article: PubMed Central - PubMed

Affiliation: Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710, Korea.

ABSTRACT
In patients with non-ischemic cardiomyopathy (NICM), risk stratification for sudden cardiac death (SCD) and selection of patients who would benefit from prophylactic implantable cardioverter-defibrillators remains challenging. We aim to discuss the evidence of cardiac magnetic resonance (CMR)-derived myocardial scar for the prediction of adverse cardiovascular outcomes in NICM. From the 15 studies analyzed, with a total of 2747 patients, the average prevalence of myocardial scar was 41%. In patients with myocardial scar, the risk for adverse cardiac events was more than 3-fold higher, and risk for arrhythmic events 5-fold higher, as compared to patients without scar. Based on the available observational, single center studies, CMR scar assessment may be a promising new tool for SCD risk stratification, which merits further investigation.

No MeSH data available.


Related in: MedlinePlus