Scar extent evaluated by late gadolinium enhancement CMR: a powerful predictor of long term appropriate ICD therapy in patients with coronary artery disease

• Published in: Journal of cardiovascular magnetic resonance 2013-01, Vol.15 (1), p.12-12, Article 12
• Main Authors: Alexandre, Joachim, Saloux, Eric, Dugué, Audrey Emmanuelle, Lebon, Alain, Lemaitre, Adrien, Roule, Vincent, Labombarda, Fabien, Provost, Nicole, Gomes, Sophie, Scanu, Patrice, Milliez, Paul
• Format: Article
• Language: English
• Subjects: Aged; Arrhythmia; Arrhythmias, Cardiac - diagnosis; Arrhythmias, Cardiac - etiology; Arrhythmias, Cardiac - physiopathology; Arrhythmias, Cardiac - prevention & control; Cardiac patients; Cardiovascular disease; Care and treatment; Computer aided design; Contrast Media; Coronary artery disease; Coronary Artery Disease - complications; Coronary Artery Disease - diagnosis; Coronary Artery Disease - physiopathology; Coronary Artery Disease - therapy; Coronary heart disease; Defibrillators, Implantable; Devices; Diagnosis; Disease prevention; Disease susceptibility; Electric Countershock - instrumentation; Female; Gadolinium; Health aspects; Heart; Heart attacks; Humans; Implantable cardioverter-defibrillators; Implantation; Implants, Artificial; Kaplan-Meier Estimate; Magnetic resonance imaging; Magnetic Resonance Imaging, Cine; Male; Medical equipment and supplies industry; Medical research; Medical test kit industry; Medicine, Experimental; Meglumine; Methods; Middle Aged; Mortality; Multivariate Analysis; Myocardium - pathology; Organometallic Compounds; Patient outcomes; Patients; Predictive Value of Tests; Primary Prevention; Proportional Hazards Models; Prosthesis; Retrospective Studies; Risk; Risk Factors; Scars; Secondary Prevention; Stroke Volume; Therapy; Time Factors; Treatment Outcome; Ventricular Function, Left
• ISSN: 1097-6647; 1532-429X; 1532-429X
• DOI: 10.1186/1532-429X-15-12

Coronary artery disease (CAD) patients are at risk for life-threatening ventricular arrhythmias (VA) related to scar tissue. Late gadolinium enhancement cardiovascular magnetic resonance (LGE-CMR) can accurately identify myocardial scar extent. It has been shown that scar extent, particularly scar transmurality, percent scar and scar mass, are associated with the occurrence of appropriate implantable cardioverter-defibrillator (ICD) therapy. However, quantification of transmurality extent has never been studied. The purpose of our study was to evaluate whether different methods quantifying scar transmurality, percent scar and scar mass (assessed with LGE-CMR) can predict appropriate ICD therapy in CAD patients with a long term follow-up period. We enrolled retrospectively 66 patients with chronic CAD referred for primary or secondary preventive ICD implantation and LGE-CMR before ICD implantation. Using LGE-CMR, scar extent was assessed by measuring scar mass, percent scar and transmural scar extent using four different methods. The median follow-up duration was 41.5 months (interquartile range 22-52). The endpoint was the occurrence of appropriate device therapy and occurred in 14 patients. Pre-ICD revascularization and transmural scar extent were significantly associated with the study endpoint but the latter was especially highly dependent on the method used. Patients with appropriate device therapy had also larger scar mass (29.6 ± 14.5 g vs 17.1 ± 8.8 g, p = 0.004), and larger percent scar (15.1 ± 8.2% vs 9.9 ± 5.6%, p = 0.03) than patients without appropriate device therapy. In multivariate analysis, scar extent variables remained significantly associated with the study end-point. In this study of CAD patients implanted for primary or secondary preventive ICD, pre-ICD revascularization and scar extent studied by LGE-CMR were significantly associated with appropriate device therapy and can identify a subgroup of CAD patients with an increased risk of life-threatening VA. Depending of the method used, transmural scar extent may vary significantly and needs further studies to obtain a validated and consensual study method.