- Oral presentation
- Open Access
Assessment of myocardial scarring improves risk stratification in patients evaluated for cardiac defibrillator implantation
© Klem et al; licensee BioMed Central Ltd. 2011
- Published: 2 February 2011
- Cardiac Magnetic Resonance
- Sudden Cardiac Death
- Myocardial Scarring
- Improve Risk Stratification
- Scar Size
We hypothesized that an assessment of myocardial scarring by cardiac magnetic resonance (CMR) would improve risk stratification.
Current sudden cardiac death (SCD) risk stratification emphasizes left-ventricular ejection fraction (LVEF), however the majority of patients suffering SCD have a preserved LVEF and many with poor LVEF do not benefit from ICD prophylaxis.
One hundred thirty-seven patients undergoing evaluation for possible ICD placement were prospectively enrolled and underwent CMR assessment of LVEF and scar. A comprehensive medical history including CAD risk factors, heart failure functional class (NYHA), and medications at the time of CMR was obtained in all patients. A total of 105 (77%) patients underwent EPS within a median of 0 days (IQR 0, 3.5) of CMR. No patient experienced a change in clinical status in the time between CMR and EPS. 103 patients (75%) had an ICD placed, generally during the initial evaluation, 2 days (IQR 1, 7) after enrollment.
Myocardial scarring detected by CMR is an independent predictor of adverse outcome in patients being considered for ICD placement. In patients with preserved LVEF, significant scarring (>5% LV) identifies a high-risk cohort similar in risk to those with LVEF less than or equal to 30%. Conversely, in patients with LVEF less than or equal to 30%, minimal-or-no scarring identifies a low-risk cohort similar to those with preserved LVEF.
This article is published under license to BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.