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Cardiac Magnetic Resonance for Prophylactic Implantable-Cardioverter Defibrillator Therapy in

Gianluca Pontone1, Andrea Igoren Guaricci2, Laura Fusini3

  • 1Centro Cardiologico Monzino IRCCS, Milan, Italy; Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy.

JACC. Cardiovascular Imaging
|May 25, 2023
PubMed

Insights

Cardiac magnetic resonance (CMR) improves risk prediction for sudden cardiac death in ischemic cardiomyopathy patients compared to echocardiography. This advanced imaging helps identify individuals who would benefit most from implantable cardioverter-defibrillator therapy.

Area of Science:

  • Cardiology
  • Medical Imaging
  • Preventive Medicine

Background:

  • Implantable cardioverter-defibrillator (ICD) therapy is standard for preventing sudden cardiac death (SCD) in ischemic cardiomyopathy (ICM) with left ventricle ejection fraction (LVEF) ≤35%.
  • Current guidelines face challenges due to low ICD intervention rates and SCD occurrences in eligible patients.

Purpose of the Study:

  • To evaluate the Net Reclassification Improvement (NRI) of using cardiac magnetic resonance (CMR) versus transthoracic echocardiography (TTE) for ICD implantation indications in ICM patients.
  • To assess the predictive value of CMR parameters for major adverse arrhythmic cardiac events (MAACE).

Main Methods:

  • The DERIVATE-ICM registry enrolled 861 patients with ICM and chronic heart failure (TTE-LVEF <50%).
  • Patients underwent both TTE and CMR imaging.
  • Major adverse arrhythmic cardiac events (MAACE) were tracked as primary endpoints during a median follow-up of 1,054 days.

Main Results:

  • MAACE occurred in 10.2% of patients.
  • Independent predictors of MAACE included left ventricular end-diastolic volume index, CMR-LVEF, and late gadolinium enhancement (LGE) mass.
  • A multiparametric CMR score demonstrated a significant NRI of 31.7% compared to the TTE-LVEF cutoff of 35% for predicting MAACE.

Conclusions:

  • The DERIVATE-ICM registry highlights the added value of CMR in risk stratification for MAACE in ICM patients.
  • CMR provides superior risk stratification compared to standard TTE for guiding ICD implantation decisions.
  • Multiparametric CMR assessment enhances the identification of high-risk patients for primary prevention of SCD.
Abstract

Keywords:
cardiac magnetic resonanceheart failureimplantable cardioverter-defibrillatorischemic dilated cardiomyopathyprimary prevention

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