Left ventricular geometry predicts ventricular tachyarrhythmia in patients with left ventricular systolic dysfunction: a comprehensive cardiovascular magnetic resonance study

Journal of Cardiovascular Magnetic Resonance

Research

Reza Nezafat¹  Shiro Nakamori¹  Long H. Ngo¹  Haisam Ismail¹  Warren J. Manning² 

[1] Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Avenue, 02215, Boston, MA, USA;Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Avenue, 02215, Boston, MA, USA;Radiology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA;

关键词: Cardiomyopathies;    Cardiovascular magnetic resonance;    Implanted cardioverter-defibrillator;    Left ventricular ejection fraction;    Primary prevention;    Sphericity index;    Ventricular arrhythmia;   

DOI  :  10.1186/s12968-017-0396-9

 received in 2017-05-03, accepted in 2017-10-09,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundMost patients with implantable cardioverter-defibrillator (ICD) implantation fail to utilize the device resulting in increasing societal costs and patient exposure to device morbidity. We sought to determine whether volumetric cardiovascular magnetic resonance (CMR) left ventricular (LV) spherical remodeling predicts future ventricular arrhythmias in primary ICD patients with reduced LV ejection fraction (EF).MethodsSixty-eight consecutive patients with transthoracic echocardiographic LVEF <35% referred for CMR prior to ICD implantation for primary prevention of sudden death were identified. Sphericity index was measured as the ratio of LV end-diastolic volume (from cine short axis stack) to the volume of a sphere with a LV end-diastolic 4-chamber length diameter.ResultsDuring a median follow-up of 55 months (interquartile range; 28–88), 15 patients (22%) received appropriate ICD therapy. Multivariable Cox’s proportional hazard modeling identified increased CMR-derived sphericity index as the strongest independent predictor of appropriate ICD therapy (hazard ratio [HR], 1.09; 95% confidence interval [CI], 1.02 to 1.16; p = 0.007). In addition, dichotomized volumetric CMR-derived sphericity index ≥0.57 carried a 4-fold hazard risk for appropriate ICD therapy, controlling for age and LVEF (HR, 4.49; 95% CI, 1.53 to 13.21; p = 0.006). When sphericity index, LVEF and mass index were used in combination, important incremental prognostic information was achieved (net reclassification improvement, 0.42; 95% CI, 0.06 to 0.77).ConclusionsThe combined assessment of LV geometry, mass index and systolic function may provide incremental prognostic information regarding ventricular arrhythmia requiring appropriate ICD therapy in primary prevention patients with reduced LVEF.

【 授权许可】

CC BY   
© The Author(s). 2017