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Cardiovascular magnetic resonance-GUIDEd management of mild to moderate left ventricular systolic dysfunction (CMR

Joseph B Selvanayagam1,2,3, Trent Hartshorne1,2, Laurent Billot4

  • 1Department of Cardiovascular Medicine, Flinders Medical Centre, Adelaide, SA, Australia.

Annals of Noninvasive Electrocardiology : the Official Journal of the International Society for Holter and Noninvasive Electrocardiology, Inc
|January 25, 2017
PubMed

Insights

Sudden cardiac death risk in heart failure patients with mild-moderate dysfunction may be identified by cardiac magnetic resonance (CMR) fibrosis. A CMR-guided strategy for implantable cardioverter-defibrillator (ICD) insertion could improve survival.

Area of Science:

  • Cardiology
  • Medical Imaging
  • Clinical Trials

Background:

  • Sudden cardiac death (SCD) is common in heart failure patients with mild-moderate left ventricular (LV) systolic dysfunction (LVEF 36-50%).
  • Current guidelines exclude these patients from primary prevention implantable cardioverter-defibrillator (ICD) therapy.
  • Cardiac magnetic resonance (CMR) evidence of replacement fibrosis may identify patients at increased risk for SCD.

Purpose of the Study:

  • To evaluate if a CMR-guided strategy for ICD insertion improves outcomes compared to standard care in patients with mild-moderate LV dysfunction and fibrosis.
  • To determine if CMR-identified fibrosis can predict life-threatening ventricular arrhythmias.

Main Methods:

  • The CMR GUIDE trial is a prospective, multicenter randomized controlled trial.
  • Patients with mild-moderate LV dysfunction and CMR-confirmed fibrosis receive optimal heart failure therapy.
  • Participants are randomized to primary prevention ICD or implantable loop recorder (ILR).
  • Primary endpoint: time to SCD or hemodynamically significant ventricular arrhythmia (VF/VT) over 4-year follow-up.

Main Results:

  • N/A - Results not yet available as this is a trial description.

Conclusions:

  • The CMR GUIDE trial will clarify the role of myocardial fibrosis in predicting ventricular arrhythmias.
  • A CMR-guided ICD strategy may significantly improve survival in this patient population.
  • Positive results could lead to changes in international clinical guidelines for heart failure management.
Abstract

Keywords:
cardiac magnetic resonance imagingimplantable cardiac defibrillatorleft ventricular systolic dysfunctionsudden cardiac deathsyncope

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