Cardiac magnetic resonance outperforms echocardiography to predict subsequent implantable cardioverter defibrillator therapies in ST-segment elevation myocardial infarction patients

Frontiers in Cardiovascular Medicine

Cardiovascular Medicine

Maria P. Lopez-Lereu¹  Jose V. Monmeneu¹  Antoni Bayés-Genís²  Cristina Albiach³  Ángel Martínez-Brotons³  Lourdes Bondanza³  Ángel Ferrero-De-Loma-Osorio³  Ricardo Ruiz-Granell³  Juan Miguel Sánchez-Gómez³  Víctor Marcos-Garcés⁴  Ana Gabaldon-Pérez⁴  Hector Merenciano-González⁴  Francisco J. Chorro⁵  Julio Nunez⁵  Vicente Bodi⁵  Elena de Dios⁶  Cesar Rios-Navarro⁷  Nerea Perez⁷  Jose Gavara⁸ 

[1] Cardiovascular Magnetic Resonance Unit, ASCIRES Biomedical Group, Valencia, Spain;Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain;Cardiology Department and Heart Failure Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Spain;Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain;Department of Cardiology, Hospital Clínico Universitario de Valencia, Valencia, Spain;Department of Cardiology, Hospital Clínico Universitario de Valencia, Valencia, Spain;INCLIVA Health Research Institute, Valencia, Spain;Department of Cardiology, Hospital Clínico Universitario de Valencia, Valencia, Spain;INCLIVA Health Research Institute, Valencia, Spain;Faculty of Medicine and Odontology, University of Valencia, Valencia, Spain;Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain;Faculty of Medicine and Odontology, University of Valencia, Valencia, Spain;INCLIVA Health Research Institute, Valencia, Spain;INCLIVA Health Research Institute, Valencia, Spain;Center for Biomaterials and Tissue Engineering, Universitat Politècnica de València, Valencia, Spain;

关键词: myocardial infarction;    implantable cardioverter-defibrillator;    cardiac magnetic resonance;    ventricular tachyarrhythmias;    left ventricular ejection fraction;   

DOI  :  10.3389/fcvm.2023.991307

 received in 2022-07-12, accepted in 2023-01-16,  发布年份 2023

来源: Frontiers

【 摘 要 】

BackgroundImplantable cardioverter defibrillators (ICD) are effective as a primary prevention measure of ventricular tachyarrhythmias in patients with ST-segment elevation myocardial infarction (STEMI) and depressed left ventricular ejection fraction (LVEF). The implications of using cardiac magnetic resonance (CMR) instead of echocardiography (Echo) to assess LVEF prior to the indication of ICD in this setting are unknown.Materials and methodsWe evaluated 52 STEMI patients (56.6 ± 11 years, 88.5% male) treated with ICD in primary prevention who underwent echocardiography and CMR prior to ICD implantation. ICD implantation was indicated based on the presence of heart failure and depressed LVEF (≤ 35%) by echocardiography, CMR, or both. Prediction of ICD therapies (ICD-T) during follow-up by echocardiography and CMR before ICD implantation was assessed.ResultsCompared to echocardiography, LVEF was lower by cardiac CMR (30.2 ± 9% vs. 37.4 ± 7.6%, p < 0.001). LVEF ≤ 35% was detected in 24 patients (46.2%) by Echo and in 42 (80.7%) by CMR. During a mean follow-up of 6.1 ± 4.2 years, 10 patients received appropriate ICD-T (3.16 ICD-T per 100 person-years): 5 direct shocks to treat very fast ventricular tachycardia or ventricular fibrillation, 3 effective antitachycardia pacing (ATP) for treatment of ventricular tachycardia, and 2 ineffective ATP followed by shock to treat ventricular tachycardia. Echo-LVEF ≤ 35% correctly predicted ICD-T in 4/10 (40%) patients and CMR-LVEF ≤ 35% in 10/10 (100%) patients. CMR-LVEF improved on Echo-LVEF for predicting ICD-T (area under the curve: 0.76 vs. 0.48, p = 0.04).ConclusionIn STEMI patients treated with ICD, assessment of LVEF by CMR outperforms Echo-LVEF to predict the subsequent use of appropriate ICD therapies.

【 授权许可】

Unknown   
Copyright © 2023 Marcos-Garcés, Perez, Gavara, Lopez-Lereu, Monmeneu, Rios-Navarro, de Dios, Merenciano-González, Gabaldon-Pérez, Ferrero-De-Loma-Osorio, Martínez-Brotons, Bondanza, Sánchez-Gómez, Albiach, Nunez, Bayés-Genís, Chorro, Ruiz-Granell and Bodi.