MYOCARDIAL SCAR CHARACTERIZATION PREDICTS DEVICE THERAPY IN CARDIAC RESYNCHRONIZATION THERAPY PATIENTS. A THREE-YEAR FOLLOW-UP
L. Cipoletta, A. Berruezo, R. Evertz, D. Penela, J. Fernández-Armenta, D. Andreu, J.M.Tolosana, E. Arbelo, J.T. Ortiz, M. Sitges, L. Mont, J. Brugada
Arrhythmia Section, Cardiology Department, Thorax Institute, Hospital Clinic, Universitat de Barcelona, Catalonia, Spain IDIBAPS (Institut d'Investigació Agustí Pi i Sunyer)
Introduction: Survival benefit of CRT-D over CRT is not clear and selecting appropriate therapy in HF patients is challenging. Myocardial scar characterization could predict long-term ventricular arrhythmias (VA).
Methods: 97 HF patients (age 63 ± 12y, NYHA class 2.7±0.7 and EF 25±8%), undergoing CRT-D implantation, were prospectively enrolled. DE-MRI was performed before implantation and analyzed with customized post-processing software. Total scar area, core area and border zone (BZ) of myocardial scar were measured. The relationship between scar characteristics and ICD therapy was analyzed.
Results: During a follow-up of 36 ± 24 months, appropriate ICD therapy occurred in 16 patients. Scar mass area <12,4g and BZ mass < 7.1g showed a negative predictive value of 96 and 97% respectively (ROC analysis, figure 1). A scar area with greater percentage of BZ was associated with a higher risk of VA (figure 2).
Conclusions: Scar mass percentage and BZ mass are independent predictors of appropriate ICD therapy. Scar heterogeneity is associated with a higher arrhythmia risk and could be used to discriminate patients who benefit from a backup defibrillator.
Figure 1. ROC curve of scar mass and border zone mass for appropriate ICD therapy
Figure 2. Patients with ICD therapy had a more heterogeneous scar (larger border zone)
