Cardiac magnetic resonance outperforms echocardiography to predict subsequent implantable cardioverter defibrillator therapies in ST-segment elevation myocardial infarction patients
Marcos-Garcés, Víctor (Hospital Clínic Universitari (València))
Perez, Nerea (Instituto de Investigación Sanitaria INCLIVA (València, Comunitat Valenciana))
Gavara Doñate, Jose (Universitat Politècnica de València)
Lopez-Lereu, Maria P. (Cardiovascular Magnetic Resonance Unit)
Monmeneu, Jose V. (Cardiovascular Magnetic Resonance Unit)
Rios-Navarro, Cesar (Instituto de Investigación Sanitaria INCLIVA (València, Comunitat Valenciana))
de Dios, Elena (University of Valencia)
Merenciano, Héctor (Hospital Clínic Universitari (València))
Gabaldon-Perez, Ana (Hospital Clínic Universitari (València))
Ferrero-De-Loma-Osorio, Ángel (Hospital Clínic Universitari (València))
Martínez-Brotons, Ángel (Hospital Clínic Universitari (València))
Bondanza, Lourdes (Hospital Clínic Universitari (València))
Sánchez-Gómez, Juan Miguel (Hospital Clínic Universitari (València))
Albiach, Cristina (Hospital Clínic Universitari (València))
Núñez, Julio (Hospital Clínic Universitari (València))
Bayés-Genís, Antoni (Universitat Autònoma de Barcelona. Departament de Medicina)
Chorro, Francisco J. (Hospital Clínic Universitari (València))
Ruiz-Granell, Ricardo (Hospital Clínic Universitari (València))
Bodi, Vicente (Hospital Clínic Universitari (València))

Date:	2023
Abstract:	Implantable 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. We 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. Compared 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). In STEMI patients treated with ICD, assessment of LVEF by CMR outperforms Echo-LVEF to predict the subsequent use of appropriate ICD therapies.
Grants:	Instituto de Salud Carlos III PI20/00637
Note:	Altres ajuts: Conselleria de Educación-Generalitat Valenciana (PROMETEO/2021/008); Sociedad Española de Cardiología (Grant SEC/FEC-INVCLI 21/024)
Rights:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Language:	Anglès
Document:	Article ; recerca ; Versió publicada
Subject:	Myocardial infarction ; Implantable cardioverter-defibrillator ; Cardiac magnetic resonance ; Ventricular tachyarrhythmias ; Left ventricular ejection fraction
Published in:	Frontiers in Cardiovascular Medicine, Vol. 10 (february 2023) , ISSN 2297-055X

DOI: 10.3389/fcvm.2023.991307
PMID: 36818338

9 p, 2.5 MB

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