Skip to main content
Journal cover image

Assessment of myocardial scarring improves risk stratification in patients evaluated for cardiac defibrillator implantation.

Publication ,  Journal Article
Klem, I; Weinsaft, JW; Bahnson, TD; Hegland, D; Kim, HW; Hayes, B; Parker, MA; Judd, RM; Kim, RJ
Published in: J Am Coll Cardiol
July 31, 2012

OBJECTIVES: We tested whether an assessment of myocardial scarring by cardiac magnetic resonance imaging (MRI) would improve risk stratification in patients evaluated for implantable cardioverter-defibrillator (ICD) implantation. BACKGROUND: Current sudden cardiac death risk stratification emphasizes left ventricular ejection fraction (LVEF); however, most patients suffering sudden cardiac death have a preserved LVEF, and many with poor LVEF do not benefit from ICD prophylaxis. METHODS: One hundred thirty-seven patients undergoing evaluation for possible ICD placement were prospectively enrolled and underwent cardiac MRI assessment of LVEF and scar. The pre-specified primary endpoint was death or appropriate ICD discharge for sustained ventricular tachyarrhythmia. RESULTS: During a median follow-up of 24 months the primary endpoint occurred in 39 patients. Whereas the rate of adverse events steadily increased with decreasing LVEF, a sharp step-up was observed for scar size >5% of left ventricular mass (hazard ratio [HR]: 5.2; 95% confidence interval [CI]: 2.0 to 13.3). On multivariable Cox proportional hazards analysis, including LVEF and electrophysiological-study results, scar size (as a continuous variable or dichotomized at 5%) was an independent predictor of adverse outcome. Among patients with LVEF >30%, those with significant scarring (>5%) had higher risk than those with minimal or no (≤5%) scarring (HR: 6.3; 95% CI: 1.4 to 28.0). Those with LVEF >30% and significant scarring had risk similar to patients with LVEF ≤30% (p = 0.56). Among patients with LVEF ≤30%, those with significant scarring again had higher risk than those with minimal or no scarring (HR: 3.9; 95% CI: 1.2 to 13.1). Those with LVEF ≤30% and minimal scarring had risk similar to patients with LVEF >30% (p = 0.71). CONCLUSIONS: Myocardial scarring detected by cardiac MRI is an independent predictor of adverse outcome in patients being considered for ICD placement. In patients with LVEF >30%, significant scarring (>5% LV) identifies a high-risk cohort similar in risk to those with LVEF ≤30%. Conversely, in patients with LVEF ≤30%, minimal or no scarring identifies a low-risk cohort similar to those with LVEF >30%.

Duke Scholars

Altmetric Attention Stats
Dimensions Citation Stats

Published In

J Am Coll Cardiol

DOI

EISSN

1558-3597

Publication Date

July 31, 2012

Volume

60

Issue

5

Start / End Page

408 / 420

Location

United States

Related Subject Headings

  • Ventricular Dysfunction, Left
  • Treatment Outcome
  • Tachycardia, Ventricular
  • Stroke Volume
  • Signal Processing, Computer-Assisted
  • Risk Assessment
  • Prospective Studies
  • Prognosis
  • Myocardium
  • Multivariate Analysis
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Klem, I., Weinsaft, J. W., Bahnson, T. D., Hegland, D., Kim, H. W., Hayes, B., … Kim, R. J. (2012). Assessment of myocardial scarring improves risk stratification in patients evaluated for cardiac defibrillator implantation. J Am Coll Cardiol, 60(5), 408–420. https://doi.org/10.1016/j.jacc.2012.02.070
Klem, Igor, Jonathan W. Weinsaft, Tristram D. Bahnson, Don Hegland, Han W. Kim, Brenda Hayes, Michele A. Parker, Robert M. Judd, and Raymond J. Kim. “Assessment of myocardial scarring improves risk stratification in patients evaluated for cardiac defibrillator implantation.J Am Coll Cardiol 60, no. 5 (July 31, 2012): 408–20. https://doi.org/10.1016/j.jacc.2012.02.070.
Klem I, Weinsaft JW, Bahnson TD, Hegland D, Kim HW, Hayes B, et al. Assessment of myocardial scarring improves risk stratification in patients evaluated for cardiac defibrillator implantation. J Am Coll Cardiol. 2012 Jul 31;60(5):408–20.
Klem, Igor, et al. “Assessment of myocardial scarring improves risk stratification in patients evaluated for cardiac defibrillator implantation.J Am Coll Cardiol, vol. 60, no. 5, July 2012, pp. 408–20. Pubmed, doi:10.1016/j.jacc.2012.02.070.
Klem I, Weinsaft JW, Bahnson TD, Hegland D, Kim HW, Hayes B, Parker MA, Judd RM, Kim RJ. Assessment of myocardial scarring improves risk stratification in patients evaluated for cardiac defibrillator implantation. J Am Coll Cardiol. 2012 Jul 31;60(5):408–420.
Journal cover image

Published In

J Am Coll Cardiol

DOI

EISSN

1558-3597

Publication Date

July 31, 2012

Volume

60

Issue

5

Start / End Page

408 / 420

Location

United States

Related Subject Headings

  • Ventricular Dysfunction, Left
  • Treatment Outcome
  • Tachycardia, Ventricular
  • Stroke Volume
  • Signal Processing, Computer-Assisted
  • Risk Assessment
  • Prospective Studies
  • Prognosis
  • Myocardium
  • Multivariate Analysis