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MAGNETOcardiography Parameters to Predict Sudden Cardiac Death (MAGNETO-SCD) or Ventricular Events From Implantable
Thomas Lachlan1, Hejie He1, Adam Miller2
1Institute for Cardio-Metabolic Medicine, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom; Warwick Medical School, University of Warwick, Coventry, United Kingdom.
Insights
Novel magnetocardiography (MCG) parameters, Rotation Score and Angular Dynamics, show promise in predicting future implantable cardioverter-defibrillator (ICD) therapies, particularly shocks, in patients at risk for sudden cardiac death.
Area of Science:
- Cardiology
- Biomedical Engineering
- Medical Imaging
Background:
- Sudden cardiac death (SCD) from ventricular arrhythmias is a global health concern.
- Current risk assessment using left ventricular ejection fraction has limitations in predicting SCD.
- Novel biomarkers are needed for improved risk stratification in patients undergoing implantable cardioverter-defibrillator (ICD) therapy.
Purpose of the Study:
- To investigate the association between magnetocardiography (MCG) parameters (Rotation Score, Angular Dynamics) and subsequent ICD therapies.
- To evaluate the potential of MCG as a tool for risk stratification in de novo ICD recipients.
- To explore the relationship between MCG parameters and specific outcomes like appropriate shocks and ventricular arrhythmias.
Main Methods:
- A prospective, multicenter observational study (Magneto-SCD) involving de novo ICD recipients.
- Utilized a portable, unshielded, room-temperature MCG device to acquire data.
- Primary outcome was any appropriate ICD therapy; secondary outcomes included shocks, arrhythmias, and mortality.
Main Results:
- Higher Rotation Score and Angular Dynamics were significantly associated with subsequent appropriate ICD therapies and shocks.
- These MCG parameters demonstrated apparent discrimination for shocks (AUC 0.82 and 0.77).
- Associations persisted after adjustment for age and ejection fraction, suggesting independence from these factors.
Conclusions:
- Novel rotation-based MCG parameters are associated with future appropriate ICD therapies, especially shocks.
- Unshielded MCG is feasible for clinical practice, potentially capturing arrhythmic substrate.
- Further validation in larger cohorts is warranted to confirm the clinical utility of Rotation Score and Angular Dynamics.
Background:
Sudden cardiac death (SCD) caused by ventricular arrhythmias remains a leading cause of mortality worldwide. Current risk stratification for implantable-cardioverter defibrillator (ICD) insertion relies heavily on left ventricular ejection fraction, which has limited discriminatory power.
Objectives:
The goal of this study was to evaluate whether established/novel magnetocardiography (MCG) parameters (Rotation Score and Angular Dynamics) were associated with subsequent ICD therapies.
Methods:
Magneto-SCD (Magnetocardiography [MCG] Parameters in the Prediction of Future ICD Therapy) was a prospective, multicenter observational study of de novo ICD recipients across 5 UK hospitals between September 2019 and November 2021. MCG data were obtained by using a portable, unshielded, room temperature device. The primary outcome was occurrence of any appropriate ICD therapy. Secondary outcomes included any appropriate shocks, sustained ventricular arrhythmias, and all-cause mortality.
Results:
A total of 104 patients were recruited (mean age ± SD 65.5 ± 12.2 years; 80% male); 90 had analyzable MCG data. After mean follow-up of 36.0 ± 17.5 months, 17 received appropriate ICD therapy, with a significantly higher median (Q1-Q3) Rotation Score (504.4 [398.5-665.3] vs 331.7 [256.6-472.2]; P = 0.005) and Angular Dynamics (3.26 [2.55-3.81] vs 2.50 [2.12-3.13]; P = 0.029). These differences in Rotation Score/Angular Dynamics were more marked in those with appropriate shocks (539.7 [428.5-674.5] vs 335.1 [256.3-476.6]; P = 0.001 and 3.348 [2.879-3.830] vs 2.492 [2.117-3.132]; P = 0.005, respectively). Each 1-SD increase in Rotation Score/Angular Dynamics was associated with a higher hazard of appropriate shocks (2.53 [95% CI: 1.53-4.18] and 2.34 [95% CI: 1.37-4.00]) and appropriate therapy. Rotation Score/Angular Dynamics showed apparent discrimination for shocks in this small data set (receiver-operating characteristic area under the curve: 0.82 and 0.77), although CIs were wide and event numbers were small. Associations persisted after limited adjustment for age and left ventricular ejection fraction, supporting an association independent of age and left ventricular ejection fraction within an ICD-selected cohort, although this requires independent validation.
Conclusions:
In the current study, novel rotation-based MCG parameters were associated with subsequent appropriate ICD therapies, particularly shocks. These exploratory findings support the feasibility of unshielded MCG in routine clinical practice and suggest that Rotation Score/Angular Dynamics may capture arrhythmic substrate and merit further investigation and validation in larger cohorts. (Magnetocardiography [MCG] Parameters in the Prediction of Future ICD Therapy [Magneto-SCD]; NCT04352816; EudraCT2019-002994-78).
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