Myocardial Fibrosis Predicts Appropriate Device Therapy in Patients With Implantable Cardioverter-Defibrillators for Primary Prevention of Sudden Cardiac Death

被引：239

作者：

Iles, Leah ^{[1
]}

Pfluger, Heinz ^{[1
]}

Lefkovits, Lisa ^{[1
]}

Butler, Michelle J. ^{[1
]}

Kistler, Peter M. ^{[1
]}

Kaye, David M. ^{[1
]}

Taylor, Andrew J. ^{[1
]}

机构：

[1] Alfred Hosp, Baker IDI Heart & Diabet Res Inst, Ctr Heart, Melbourne, Vic 3004, Australia

来源：

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY | 2011年 / 57卷 / 07期

基金：

瑞士国家科学基金会; 英国医学研究理事会;

关键词：

arrhythmia; cardiomyopathy; heart arrest; magnetic resonance imaging; CARDIOVASCULAR MAGNETIC-RESONANCE; LATE GADOLINIUM ENHANCEMENT; VENTRICULAR-TACHYCARDIA; COST-EFFECTIVENESS; HEART-FAILURE; NONISCHEMIC CARDIOMYOPATHY; DILATED CARDIOMYOPATHY; EJECTION FRACTION; ARRHYTHMIAS; RECORDINGS;

D O I：

10.1016/j.jacc.2010.06.062

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Objectives The purpose of this study was to evaluate the association between regional myocardial fibrosis and ventricular arrhythmias in patients with cardiomyopathy. Background Patients with heart failure are at risk of sudden cardiac death (SCD). Current guidelines recommend implantable cardioverter-defibrillator (ICD) devices for a subgroup based on impaired left ventricular function. A significant proportion of devices never discharge, hence a more accurate method for targeting those at risk is desirable. Methods We prospectively enrolled 103 patients meeting criteria for ICD implantation for primary prevention of SCD. Cardiac magnetic resonance imaging was performed before device implantation. Regional fibrosis was identified with late gadolinium enhancement (LGE). Results Median follow-up was 573 days (interquartile range: 379 to 863 days). The LGE identified regional fibrosis in 31 of 61 (51%) patients with nonischemic cardiomyopathy (NICM) and in all 42 patients with ischemic cardiomyopathy (ICM). There was a 29% (9 of 31) discharge rate in the NICM group with LGE compared with a 14% (6 of 42) discharge rate in the ICM group (p = NS). There were no ICD discharges in the NICM group without LGE, which was significantly lower than the rate observed in both the ICM patients (p = 0.04) and the NICM patients with LGE (p < 0.01). Left ventricular ejection fraction was similar in patients with and without device therapy (24 +/- 12% vs. 26 +/- 8%, p = NS) and those with or without LGE (25 +/- 9% vs. 26 +/- 9%, p = NS). Conclusions Patients with advanced cardiomyopathy and myocardial fibrosis demonstrated by LGE on cardiac magnetic resonance imaging have a high likelihood of appropriate ICD therapy. Correspondingly, absence of LGE may indicate a lower risk for malignant ventricular arrhythmias. (J Am Coll Cardiol 2011; 57: 821-8) (C) 2011 by the American College of Cardiology Foundation

引用

页码：821 / 828

页数：8

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