PMID- 21310318
OWN - NLM
STAT- MEDLINE
DCOM- 20110324
LR  - 20220310
IS  - 1558-3597 (Electronic)
IS  - 0735-1097 (Linking)
VI  - 57
IP  - 7
DP  - 2011 Feb 15
TI  - Myocardial fibrosis predicts appropriate device therapy in patients with 
      implantable cardioverter-defibrillators for primary prevention of sudden cardiac 
      death.
PG  - 821-8
LID - 10.1016/j.jacc.2010.06.062 [doi]
AB  - OBJECTIVES: The purpose of this study was to evaluate the association between 
      regional myocardial fibrosis and ventricular arrhythmias in patients with 
      cardiomyopathy. BACKGROUND: Patients with heart failure are at risk of sudden 
      cardiac death (SCD). Current guidelines recommend implantable 
      cardioverter-defibrillator (ICD) devices for a subgroup based on impaired left 
      ventricular function. A significant proportion of devices never discharge, hence 
      a more accurate method for targeting those at risk is desirable. METHODS: We 
      prospectively enrolled 103 patients meeting criteria for ICD implantation for 
      primary prevention of SCD. Cardiac magnetic resonance imaging was performed 
      before device implantation. Regional fibrosis was identified with late gadolinium 
      enhancement (LGE). RESULTS: Median follow-up was 573 days (interquartile range: 
      379 to 863 days). The LGE identified regional fibrosis in 31 of 61 (51%) patients 
      with nonischemic cardiomyopathy (NICM) and in all 42 patients with ischemic 
      cardiomyopathy (ICM). There was a 29% (9 of 31) discharge rate in the NICM group 
      with LGE compared with a 14% (6 of 42) discharge rate in the ICM group (p = NS). 
      There were no ICD discharges in the NICM group without LGE, which was 
      significantly lower than the rate observed in both the ICM patients (p = 0.04) 
      and the NICM patients with LGE (p < 0.01). Left ventricular ejection fraction was 
      similar in patients with and without device therapy (24 +/- 12% vs. 26 +/- 8%, p = 
      NS) and those with or without LGE (25 +/- 9% vs. 26 +/- 9%, p = NS). CONCLUSIONS: 
      Patients with advanced cardiomyopathy and myocardial fibrosis demonstrated by LGE 
      on cardiac magnetic resonance imaging have a high likelihood of appropriate ICD 
      therapy. Correspondingly, absence of LGE may indicate a lower risk for malignant 
      ventricular arrhythmias.
CI  - Copyright (c) 2011 American College of Cardiology Foundation. Published by Elsevier 
      Inc. All rights reserved.
FAU - Iles, Leah
AU  - Iles L
AD  - Alfred Hospital and Baker IDI Heart and Diabetes Research Institute, Melbourne, 
      Australia.
FAU - Pfluger, Heinz
AU  - Pfluger H
FAU - Lefkovits, Lisa
AU  - Lefkovits L
FAU - Butler, Michelle J
AU  - Butler MJ
FAU - Kistler, Peter M
AU  - Kistler PM
FAU - Kaye, David M
AU  - Kaye DM
FAU - Taylor, Andrew J
AU  - Taylor AJ
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - J Am Coll Cardiol
JT  - Journal of the American College of Cardiology
JID - 8301365
SB  - IM
CIN - J Am Coll Cardiol. 2011 Feb 15;57(7):829-30. PMID: 21310319
CIN - J Am Coll Cardiol. 2011 Sep 6;58(11):1194; author reply 1194-5. PMID: 21884963
MH  - Cardiomyopathies/*pathology
MH  - Death, Sudden, Cardiac/*prevention & control
MH  - *Defibrillators, Implantable
MH  - Female
MH  - Fibrosis
MH  - Follow-Up Studies
MH  - Heart Failure/*therapy
MH  - Humans
MH  - Magnetic Resonance Imaging
MH  - Male
MH  - Middle Aged
MH  - Myocardium/*pathology
MH  - Prospective Studies
MH  - Ventricular Dysfunction, Left/diagnosis
EDAT- 2011/02/12 06:00
MHDA- 2011/03/25 06:00
CRDT- 2011/02/12 06:00
PHST- 2010/03/17 00:00 [received]
PHST- 2010/06/01 00:00 [revised]
PHST- 2010/06/21 00:00 [accepted]
PHST- 2011/02/12 06:00 [entrez]
PHST- 2011/02/12 06:00 [pubmed]
PHST- 2011/03/25 06:00 [medline]
AID - S0735-1097(10)04725-X [pii]
AID - 10.1016/j.jacc.2010.06.062 [doi]
PST - ppublish
SO  - J Am Coll Cardiol. 2011 Feb 15;57(7):821-8. doi: 10.1016/j.jacc.2010.06.062.