PMID- 30107489
OWN - NLM
STAT- MEDLINE
DCOM- 20200814
LR  - 20200814
IS  - 1522-9645 (Electronic)
IS  - 0195-668X (Linking)
VI  - 40
IP  - 6
DP  - 2019 Feb 7
TI  - Reduction in mortality from implantable cardioverter-defibrillators in 
      non-ischaemic cardiomyopathy patients is dependent on the presence of left 
      ventricular scar.
PG  - 542-550
LID - 10.1093/eurheartj/ehy437 [doi]
AB  - AIMS: In patients with non-ischaemic cardiomyopathy (NICM), the mortality benefit 
      of a primary prevention implantable cardioverter-defibrillator (ICD) has been 
      challenged. Left ventricular (LV) scar identified by cardiac magnetic resonance 
      (CMR) imaging is associated with a high risk of malignant arrhythmia in NICM. We 
      aimed to determine the impact of LV scar on the mortality benefit from a primary 
      prevention ICD in NICM. METHODS AND RESULTS: We recruited 452 consecutive heart 
      failure patients [New York Heart Association (NYHA) Class II/III] with NICM and 
      LV ejection fraction </=35% from a state-wide CMR service. All patients fulfilled 
      European Society of Cardiology guidelines for primary prevention ICD 
      implantation; however, the decision to implant was at the treating physician's 
      discretion. Baseline clinical and CMR data were recorded prospectively and heart 
      failure mortality risk (MAGGIC score) was calculated. The primary study outcome 
      measurement was all-cause mortality based on presence or absence of ICD, 
      stratified by LV scar. Median follow-up was 37.9 months and there was no 
      difference in MAGGIC score between those who did and did not receive a primary 
      prevention ICD (19.30 +/- 5.46 vs. 18.90 +/- 5.67, P = 0.50). In patients without LV 
      scar, ICD implantation was not associated with improved mortality [hazard ratio 
      (HR) = 1.22, 95% confidence interval (CI): 0.53-2.78, P = 0.64]. In patients with 
      LV scar, ICD implantation was independently associated with reduced mortality 
      (HR = 0.45, 95% CI: 0.26-0.77, P = 0.003). CONCLUSIONS: In patients with NICM, 
      primary prevention ICD implantation is only associated with reduced mortality in 
      patients with LV scar. This may enable more effective selection of NICM patients 
      for ICD implantation compared with current guidelines.
FAU - Gutman, Sarah J
AU  - Gutman SJ
AD  - Department of Cardiology, The Alfred Hospital, Commercial Road, Melbourne, 
      Australia.
AD  - Imaging Research, Baker Heart and Diabetes Institute, Commercial Road, Melbourne, 
      Australia.
AD  - Department of Medicine, Nursing and Health Sciences, Monash University, 
      Wellington Road, Melbourne, Australia.
FAU - Costello, Benedict T
AU  - Costello BT
AD  - Department of Cardiology, The Alfred Hospital, Commercial Road, Melbourne, 
      Australia.
AD  - Imaging Research, Baker Heart and Diabetes Institute, Commercial Road, Melbourne, 
      Australia.
AD  - Department of Medicine, Nursing and Health Sciences, Monash University, 
      Wellington Road, Melbourne, Australia.
FAU - Papapostolou, Stavroula
AU  - Papapostolou S
AD  - Department of Cardiology, The Alfred Hospital, Commercial Road, Melbourne, 
      Australia.
AD  - Department of Medicine, Nursing and Health Sciences, Monash University, 
      Wellington Road, Melbourne, Australia.
FAU - Voskoboinik, Aleksandr
AU  - Voskoboinik A
AD  - Department of Cardiology, The Alfred Hospital, Commercial Road, Melbourne, 
      Australia.
AD  - Imaging Research, Baker Heart and Diabetes Institute, Commercial Road, Melbourne, 
      Australia.
AD  - Department of Cardiology, The Royal Melbourne Hospital, Grattan Street, 
      Melbourne, Australia.
AD  - Department of Medicine, Dentistry and Health Sciences, The University of 
      Melbourne, Grattan Street, Melbourne, Australia.
FAU - Iles, Leah
AU  - Iles L
AD  - Department of Cardiology, The Alfred Hospital, Commercial Road, Melbourne, 
      Australia.
AD  - Imaging Research, Baker Heart and Diabetes Institute, Commercial Road, Melbourne, 
      Australia.
FAU - Ja, Johnson
AU  - Ja J
AD  - Department of Cardiology, The Alfred Hospital, Commercial Road, Melbourne, 
      Australia.
FAU - Hare, James L
AU  - Hare JL
AD  - Department of Cardiology, The Alfred Hospital, Commercial Road, Melbourne, 
      Australia.
AD  - Imaging Research, Baker Heart and Diabetes Institute, Commercial Road, Melbourne, 
      Australia.
FAU - Ellims, Andris
AU  - Ellims A
AD  - Department of Cardiology, The Alfred Hospital, Commercial Road, Melbourne, 
      Australia.
FAU - Kistler, Peter M
AU  - Kistler PM
AD  - Department of Cardiology, The Alfred Hospital, Commercial Road, Melbourne, 
      Australia.
AD  - Imaging Research, Baker Heart and Diabetes Institute, Commercial Road, Melbourne, 
      Australia.
AD  - Department of Medicine, Nursing and Health Sciences, Monash University, 
      Wellington Road, Melbourne, Australia.
AD  - Department of Medicine, Dentistry and Health Sciences, The University of 
      Melbourne, Grattan Street, Melbourne, Australia.
FAU - Marwick, Thomas H
AU  - Marwick TH
AD  - Department of Cardiology, The Alfred Hospital, Commercial Road, Melbourne, 
      Australia.
AD  - Imaging Research, Baker Heart and Diabetes Institute, Commercial Road, Melbourne, 
      Australia.
AD  - Department of Medicine, Nursing and Health Sciences, Monash University, 
      Wellington Road, Melbourne, Australia.
FAU - Taylor, Andrew J
AU  - Taylor AJ
AD  - Department of Cardiology, The Alfred Hospital, Commercial Road, Melbourne, 
      Australia.
AD  - Imaging Research, Baker Heart and Diabetes Institute, Commercial Road, Melbourne, 
      Australia.
AD  - Department of Medicine, Nursing and Health Sciences, Monash University, 
      Wellington Road, Melbourne, Australia.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - England
TA  - Eur Heart J
JT  - European heart journal
JID - 8006263
SB  - IM
CIN - Eur Heart J. 2019 Feb 7;40(6):551-552. PMID: 30329037
CIN - Eur Heart J. 2019 Sep 14;40(35):2997. PMID: 31363745
CIN - Eur Heart J. 2019 Sep 14;40(35):2996. PMID: 31363761
MH  - Adult
MH  - Aged
MH  - Cardiomyopathies/diagnostic imaging/*mortality/pathology/therapy
MH  - Cicatrix/*pathology
MH  - *Defibrillators, Implantable
MH  - Female
MH  - Heart Ventricles/*pathology
MH  - Humans
MH  - Magnetic Resonance Imaging
MH  - Male
MH  - Middle Aged
MH  - Propensity Score
MH  - Survival Analysis
EDAT- 2018/08/15 06:00
MHDA- 2020/08/15 06:00
CRDT- 2018/08/15 06:00
PHST- 2018/02/05 00:00 [received]
PHST- 2018/07/06 00:00 [accepted]
PHST- 2018/08/15 06:00 [pubmed]
PHST- 2020/08/15 06:00 [medline]
PHST- 2018/08/15 06:00 [entrez]
AID - 5070406 [pii]
AID - 10.1093/eurheartj/ehy437 [doi]
PST - ppublish
SO  - Eur Heart J. 2019 Feb 7;40(6):542-550. doi: 10.1093/eurheartj/ehy437.