title: Myocardial scar characteristics based on cardiac magnetic resonance imaging is associated with ventricular tachyarrhythmia in patients with ischemic cardiomyopathy.
abstract: OBJECTIVE
  We hypothesized that myocardial scar characterization using cardiac magnetic resonance imaging (CMR) may be associated with the occurrence of ventricular tachyarrhythmia (VT), appropriate implantable cardioverter-defibrillator (ICD) therapy and mortality.
  
  
  BACKGROUND
  Since a minority of patients with prophylactic ICD implantation receive appropriate ICD therapy, there is a need for more effective risk stratification for primary prevention in patients with ischemic cardiomyopathy.
  
  
  RESULTS
  In 99 patients with ischemic cardiomyopathy, CMR was performed prior to ICD implantation. We assessed if CMR indices (cardiac mass, LVEF) and CMR scar characteristics (infarct core mass, peri-infarction mass and the ratio's between left ventricular mass, infarct core mass and peri-infarction mass) were associated with outcome. The primary endpoint was sustained VT and/or appropriate ICD therapy. The secondary endpoint was all-cause mortality. During a median follow-up of 5.4 years (IQR 4.5-6.6 years), 34 patients reached the primary end-point (17 appropriate ICD shocks) and 26 patients died. In multivariable Cox regression analysis, peri-infarction to core-infarction ratio (HR 2.01, 95%CI: 1.17-3.44, p=0.01) was independently and significantly associated with the primary endpoint, whereas NYHA-class and lower LVEF were not. Conversely, age (HR 1.06, 95% CI: 1.01-1.12, p=0.02) and lower LVEF (HR 0.95, 95% CI: 0.91-1.00, p=0.04) were independently associated with all-cause mortality, mainly due to heart failure.
  
  
  CONCLUSIONS
  A relatively large peri-infarction mass is associated with sustained VT and/or appropriate ICD therapy, whereas age and lower LVEF are associated with mortality. CMR based tissue characterization could aid in the prediction of specific outcome measures and in clinical decision making.
authors.affiliation: Department of Cardiology, Isala Klinieken, Zwolle, the Netherlands.
authors.forename: Fatma
authors.initials: F
authors.lastname: Demirel
authors.affiliation: Department of Cardiology, Isala Klinieken, Zwolle, the Netherlands.
authors.forename: Ahmet
authors.initials: A
authors.lastname: Adiyaman
authors.affiliation: Department of Cardiology, Isala Klinieken, Zwolle, the Netherlands.
authors.forename: Jorik R
authors.initials: JR
authors.lastname: Timmer
authors.affiliation: Department of Cardiology, Isala Klinieken, Zwolle, the Netherlands.
authors.forename: Jan-Henk E
authors.initials: JH
authors.lastname: Dambrink
authors.affiliation: Department of Cardiology, Isala Klinieken, Zwolle, the Netherlands.
authors.forename: Mariël
authors.initials: M
authors.lastname: Kok
authors.affiliation: Department of Radiology, Diaconessenhuis, Meppel, the Netherlands.
authors.forename: Willem Jan
authors.initials: WJ
authors.lastname: Boeve
authors.affiliation: Department of Cardiology, Isala Klinieken, Zwolle, the Netherlands. Electronic address: v.r.c.derks@isala.nl.
authors.forename: Arif
authors.initials: A
authors.lastname: Elvan
mesh_terms: D000368:Aged; D009202:Cardiomyopathies / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D002921:Cicatrix / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D017147:Defibrillators, Implantable / Q000639:trends; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008137:Longitudinal Studies; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D011446:Prospective Studies; D017180:Tachycardia, Ventricular / Q000150:complications / Q000175:diagnosis* / Q000628:therapy
keywords: Cardiac magnetic resonance imaging; Implantable cardioverter defibrillator; Late gadolinium enhancement; Mortality; Ventricular tachyarrhythmia