CMR DENSE and the Seattle Heart Failure Model Inform Survival and Arrhythmia Risk After CRT
Kenneth C Bilchick1, Daniel A Auger2, Mohammad Abdishektaei2
1Department of Medicine, University of Virginia Health System, Charlottesville, Virginia.
Insights
Combining Seattle Heart Failure Model (SHFM-D) with cardiac magnetic resonance (CMR) DENSE strain imaging improves risk prediction for patients receiving cardiac resynchronization therapy (CRT) defibrillators, enhancing patient outcomes.
Area of Science:
- Cardiology
- Medical Imaging
- Biomedical Engineering
Background:
- Seattle Heart Failure Model (SHFM-D) is a standard risk stratification tool for heart failure patients with implantable cardioverter-defibrillators (ICDs).
- Cardiac magnetic resonance (CMR) offers detailed cardiac structure and function insights, crucial for understanding heart failure progression.
Purpose of the Study:
- To evaluate if combining SHFM-D with CMR DENSE strain imaging provides additive prognostic value for patients undergoing cardiac resynchronization therapy (CRT) defibrillator implantation.
- To assess the predictive performance of novel CMR-derived dyssynchrony parameters in this patient cohort.
Main Methods:
- Utilized CMR Displacement Encoding with Stimulated Echoes (DENSE) strain imaging to derive the circumferential uniformity ratio estimate with singular value decomposition (CURE-SVD) dyssynchrony parameter.
- Calculated SHFM-D using clinical data and employed multivariable Cox regression to analyze the primary endpoint (death, heart transplantation, LVAD, or appropriate ICD therapies).
Main Results:
- Both SHFM-D and CURE-SVD were independently associated with the primary endpoint.
- A combined favorable prognostic group (low CURE-SVD and SHFM-D) showed significantly lower appropriate ICD therapy rates and higher 4-year survival.
- CURE-SVD derived from DENSE imaging demonstrated a stronger correlation with CRT response compared to feature tracking methods.
Conclusions:
- The integration of CMR DENSE strain imaging with the SHFM-D model offers effective risk stratification for CRT defibrillator patients.
- This combined approach presents a novel paradigm for improving prognostic accuracy and guiding device selection in heart failure management.
Objectives:
This study sought to determine if combining the Seattle Heart Failure Model (SHFM-D) and cardiac magnetic resonance (CMR) provides complementary prognostic data for patients with cardiac resynchronization therapy (CRT) defibrillators.
Background:
The SHFM-D is among the most widely used risk stratification models for overall survival in patients with heart failure and implantable cardioverter-defibrillators (ICDs), and CMR provides highly detailed information regarding cardiac structure and function.
Methods:
CMR Displacement Encoding with Stimulated Echoes (DENSE) strain imaging was used to generate the circumferential uniformity ratio estimate with singular value decomposition (CURE-SVD) circumferential strain dyssynchrony parameter, and the SHFM-D was determined from clinical parameters. Multivariable Cox proportional hazards regression was used to determine adjusted hazard ratios and time-dependent areas under the curve for the primary endpoint of death, heart transplantation, left ventricular assist device, or appropriate ICD therapies.
Results:
The cohort consisted of 100 patients (65.5 [interquartile range 57.7 to 72.7] years; 29% female), of whom 47% had the primary clinical endpoint and 18% had appropriate ICD therapies during a median follow-up of 5.3 years. CURE-SVD and the SHFM-D were independently associated with the primary endpoint (SHFM-D: hazard ratio: 1.47/SD; 95% confidence interval: 1.06 to 2.03; p = 0.02) (CURE-SVD: hazard ratio: 1.54/SD; 95% confidence interval: 1.12 to 2.11; p = 0.009). Furthermore, a favorable prognostic group (Group A, with CURE-SVD <0.60 and SHFM-D <0.70) comprising approximately one-third of the patients had a very low rate of appropriate ICD therapies (1.5% per year) and a greater (90%) 4-year survival compared with Group B (CURE-SVD ≥0.60 or SHFM-D ≥0.70) patients (p = 0.02). CURE-SVD with DENSE had a stronger correlation with CRT response (r = -0.57; p < 0.0001) than CURE-SVD with feature tracking (r = -0.28; p = 0.004).
Conclusions:
A combined approach to risk stratification using CMR DENSE strain imaging and a widely used clinical risk model, the SHFM-D, proved to be effective in this cohort of patients referred for CRT defibrillators. The combined use of CMR and clinical risk models represents a promising and novel paradigm to inform prognosis and device selection in the future.
Related Concept Videos
01:30Cardiomyopathy II: Dilated Cardiomyopathy
01:29Cardiomyopathy III: Hypertrophic Cardiomyopathy
01:29Cardiomyopathy IV: Restrictive Cardiomyopathy
01:21Imaging Studies for Cardiovascular System IV: CMRI
01:29Cardiomyopathy V: Interprofessional Care