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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 all-cause mortality.Forest plot comparing prognosis of NICM patients with and without scar, detected by delayed-enhancement MRI. CI = confidence interval, NICM = non-ischemic cardiomyopathy, SE = standard error
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Figure 3: Individual and pooled hazard ratios from univariate Cox proportional hazards analysis for risk of all-cause mortality.Forest plot comparing prognosis of NICM patients with and without scar, detected by delayed-enhancement MRI. CI = confidence interval, NICM = non-ischemic cardiomyopathy, SE = standard error

Mentions: Three studies with 1241 patients and a mean follow-up of 4 years, reported the relation of scar presence to all-cause mortality and heart transplant in NICM patients. As shown in Figure 3, patients with scar had a higher event rate compared to patients without scar (HR, 2.5; 95% confidence interval, 1.8-3.4). Eight studies with a total of 1367 patients reported the relation of myocardial scar to arrhythmic events, which were mostly SCD, aborted SCD, appropriate ICD shocks, and sustained VT (Fig. 4). In this analysis, we included results from all studies that considered arrhythmic events either as primary study endpoint (313446), secondary endpoint or composite of a combined endpoint (19232830). Patients with myocardial scar had a 5-fold risk of arrhythmic events compared to those NICM patients without scar (HR, 5.0; 95% confidence interval, 3.2-7.7).


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 all-cause mortality.Forest plot comparing prognosis of NICM patients with and without scar, detected by delayed-enhancement MRI. CI = confidence interval, NICM = non-ischemic cardiomyopathy, SE = standard error
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 3: Individual and pooled hazard ratios from univariate Cox proportional hazards analysis for risk of all-cause mortality.Forest plot comparing prognosis of NICM patients with and without scar, detected by delayed-enhancement MRI. CI = confidence interval, NICM = non-ischemic cardiomyopathy, SE = standard error
Mentions: Three studies with 1241 patients and a mean follow-up of 4 years, reported the relation of scar presence to all-cause mortality and heart transplant in NICM patients. As shown in Figure 3, patients with scar had a higher event rate compared to patients without scar (HR, 2.5; 95% confidence interval, 1.8-3.4). Eight studies with a total of 1367 patients reported the relation of myocardial scar to arrhythmic events, which were mostly SCD, aborted SCD, appropriate ICD shocks, and sustained VT (Fig. 4). In this analysis, we included results from all studies that considered arrhythmic events either as primary study endpoint (313446), secondary endpoint or composite of a combined endpoint (19232830). Patients with myocardial scar had a 5-fold risk of arrhythmic events compared to those NICM patients without scar (HR, 5.0; 95% confidence interval, 3.2-7.7).

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