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Left ventricular geometry predicts ventricular tachyarrhythmia in patients with left ventricular systolic dysfunction: a comprehensive cardiovascular magnetic resonance study
BACKGROUND: Most patients with implantable cardioverter-defibrillator (ICD) implantation fail to utilize the device resulting in increasing societal costs and patient exposure to device morbidity. We sought to determine whether volumetric cardiovascular magnetic resonance (CMR) left ventricular (LV)...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2017
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5651593/ https://www.ncbi.nlm.nih.gov/pubmed/29058590 http://dx.doi.org/10.1186/s12968-017-0396-9 |
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author | Nakamori, Shiro Ismail, Haisam Ngo, Long H. Manning, Warren J. Nezafat, Reza |
author_facet | Nakamori, Shiro Ismail, Haisam Ngo, Long H. Manning, Warren J. Nezafat, Reza |
author_sort | Nakamori, Shiro |
collection | PubMed |
description | BACKGROUND: Most patients with implantable cardioverter-defibrillator (ICD) implantation fail to utilize the device resulting in increasing societal costs and patient exposure to device morbidity. We sought to determine whether volumetric cardiovascular magnetic resonance (CMR) left ventricular (LV) spherical remodeling predicts future ventricular arrhythmias in primary ICD patients with reduced LV ejection fraction (EF). METHODS: Sixty-eight consecutive patients with transthoracic echocardiographic LVEF <35% referred for CMR prior to ICD implantation for primary prevention of sudden death were identified. Sphericity index was measured as the ratio of LV end-diastolic volume (from cine short axis stack) to the volume of a sphere with a LV end-diastolic 4-chamber length diameter. RESULTS: During a median follow-up of 55 months (interquartile range; 28–88), 15 patients (22%) received appropriate ICD therapy. Multivariable Cox’s proportional hazard modeling identified increased CMR-derived sphericity index as the strongest independent predictor of appropriate ICD therapy (hazard ratio [HR], 1.09; 95% confidence interval [CI], 1.02 to 1.16; p = 0.007). In addition, dichotomized volumetric CMR-derived sphericity index ≥0.57 carried a 4-fold hazard risk for appropriate ICD therapy, controlling for age and LVEF (HR, 4.49; 95% CI, 1.53 to 13.21; p = 0.006). When sphericity index, LVEF and mass index were used in combination, important incremental prognostic information was achieved (net reclassification improvement, 0.42; 95% CI, 0.06 to 0.77). CONCLUSIONS: The combined assessment of LV geometry, mass index and systolic function may provide incremental prognostic information regarding ventricular arrhythmia requiring appropriate ICD therapy in primary prevention patients with reduced LVEF. |
format | Online Article Text |
id | pubmed-5651593 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2017 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-56515932017-10-26 Left ventricular geometry predicts ventricular tachyarrhythmia in patients with left ventricular systolic dysfunction: a comprehensive cardiovascular magnetic resonance study Nakamori, Shiro Ismail, Haisam Ngo, Long H. Manning, Warren J. Nezafat, Reza J Cardiovasc Magn Reson Research BACKGROUND: Most patients with implantable cardioverter-defibrillator (ICD) implantation fail to utilize the device resulting in increasing societal costs and patient exposure to device morbidity. We sought to determine whether volumetric cardiovascular magnetic resonance (CMR) left ventricular (LV) spherical remodeling predicts future ventricular arrhythmias in primary ICD patients with reduced LV ejection fraction (EF). METHODS: Sixty-eight consecutive patients with transthoracic echocardiographic LVEF <35% referred for CMR prior to ICD implantation for primary prevention of sudden death were identified. Sphericity index was measured as the ratio of LV end-diastolic volume (from cine short axis stack) to the volume of a sphere with a LV end-diastolic 4-chamber length diameter. RESULTS: During a median follow-up of 55 months (interquartile range; 28–88), 15 patients (22%) received appropriate ICD therapy. Multivariable Cox’s proportional hazard modeling identified increased CMR-derived sphericity index as the strongest independent predictor of appropriate ICD therapy (hazard ratio [HR], 1.09; 95% confidence interval [CI], 1.02 to 1.16; p = 0.007). In addition, dichotomized volumetric CMR-derived sphericity index ≥0.57 carried a 4-fold hazard risk for appropriate ICD therapy, controlling for age and LVEF (HR, 4.49; 95% CI, 1.53 to 13.21; p = 0.006). When sphericity index, LVEF and mass index were used in combination, important incremental prognostic information was achieved (net reclassification improvement, 0.42; 95% CI, 0.06 to 0.77). CONCLUSIONS: The combined assessment of LV geometry, mass index and systolic function may provide incremental prognostic information regarding ventricular arrhythmia requiring appropriate ICD therapy in primary prevention patients with reduced LVEF. BioMed Central 2017-10-23 /pmc/articles/PMC5651593/ /pubmed/29058590 http://dx.doi.org/10.1186/s12968-017-0396-9 Text en © The Author(s). 2017 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
spellingShingle | Research Nakamori, Shiro Ismail, Haisam Ngo, Long H. Manning, Warren J. Nezafat, Reza Left ventricular geometry predicts ventricular tachyarrhythmia in patients with left ventricular systolic dysfunction: a comprehensive cardiovascular magnetic resonance study |
title | Left ventricular geometry predicts ventricular tachyarrhythmia in patients with left ventricular systolic dysfunction: a comprehensive cardiovascular magnetic resonance study |
title_full | Left ventricular geometry predicts ventricular tachyarrhythmia in patients with left ventricular systolic dysfunction: a comprehensive cardiovascular magnetic resonance study |
title_fullStr | Left ventricular geometry predicts ventricular tachyarrhythmia in patients with left ventricular systolic dysfunction: a comprehensive cardiovascular magnetic resonance study |
title_full_unstemmed | Left ventricular geometry predicts ventricular tachyarrhythmia in patients with left ventricular systolic dysfunction: a comprehensive cardiovascular magnetic resonance study |
title_short | Left ventricular geometry predicts ventricular tachyarrhythmia in patients with left ventricular systolic dysfunction: a comprehensive cardiovascular magnetic resonance study |
title_sort | left ventricular geometry predicts ventricular tachyarrhythmia in patients with left ventricular systolic dysfunction: a comprehensive cardiovascular magnetic resonance study |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5651593/ https://www.ncbi.nlm.nih.gov/pubmed/29058590 http://dx.doi.org/10.1186/s12968-017-0396-9 |
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