Abstract
Background
In this study we aimed to investigate left atrial (LA) function, measured from routine
cine cardiovascular magnetic resonance imaging, to determine its value for the prediction
of sudden cardiac death (SCD) or appropriate implantable cardioverter defibrillator
(ICD) shock in patients who received primary prevention ICD implantation.
Methods
We studied 203 patients with ischemic or idiopathic nonischemic dilated cardiomyopathy
who underwent cardiovascular magnetic resonance imaging before primary prevention
ICD implantation. LA volumes were measured at end-diastole and end-systole from 4-
and 2-chamber cine images, and LA emptying function (LAEF) calculated. Patients were
followed for the primary composite end point of SCD or appropriate ICD shock.
Results
Mean age was 61 ± 12 years with a mean left ventricular ejection fraction of 24 ±
7%. The mean LAEF was 27 ± 15% (range, 0.9%-73%). At a median follow-up of 1639 days,
35 patients (17%) experienced the primary composite outcome. LAEF was strongly associated
with the primary outcome (P = 0.001); patients with an LAEF ≤ 30% experienced a cumulative event rate of 26.1%
vs 5.7% (hazard ratio, 5.5; P < 0.001) in patients above this cutoff. This finding was maintained in multivariable
analysis (hazard ratio, 4.7; P = 0.002) and was consistently shown in the ischemic and nonischemic dilated cardiomyopathy
subgroups.
Conclusions
LAEF is a simple, powerful, and independent predictor of SCD in patients being referred
for primary prevention ICD implantation.
Résumé
Introduction
Dans la présente étude, nous avions pour objectif d’examiner la fonction auriculaire
gauche (AG), mesuré par ciné-imagerie cardiovasculaire par résonance magnétique (ciné-IRM
cardiovasculaire) systématique, pour déterminer sa valeur prédictive de la mort subite
d’origine cardiaque (MSOC) ou de la décharge électrique appropriée du défibrillateur
cardioverteur implantable (DCI) chez les patients qui subissaient une implantation
de DAI en prévention primaire.
Méthodes
Les 203 participants à l’étude étaient des patients ayant une cardiomyopathie dilatée
ischémique ou non ischémique idiopathique qui avaient subi une IRM cardiovasculaire
avant l’implantation du DCI en prévention primaire. Nous avons mesuré le volume de
l’AG en fin de diastole et de systole à partir d’images de ciné-IRM, coupes 4 et 2
cavités, et calculé la fraction de vidange de l’AG (FVAG). Le suivi des patients a
porté sur le critère de jugement principal composite de MSOC ou de décharge électrique
appropriée du DCI.
Résultats
L’âge moyen était de 61 ± 12 ans et la fraction d’éjection ventriculaire gauche moyenne
était de 24 ± 7 %. La FVAG moyenne était de 27 ± 15 % (étendue, 0,9 %-73 %). Au suivi
médian de 1639 jours, 35 patients (17 %) ont atteint le critère de jugement principal
composite. La FVAG a fortement été associée au critère de jugement principal (P = 0,001); les patients ayant une FVAG ≤ 30 % ont expérimenté un taux cumulatif d’événements
de 26,1 % vs 5,7 % (rapport de risque, 5,5; P < 0,001) chez les patients au-dessus de cette limite. Ce résultat a été maintenu
dans l’analyse multivariable (rapport de risque, 4,7; P = 0,002) et a été démontré de manière constante dans les sous-groupes de cardiomyopathie
dilatée ischémique et non ischémique.
Conclusions
La FVAG est un prédicteur simple, puissant et indépendant de la MSOC chez les patients
dirigés pour une implantation de DCI en prévention primaire.
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Article info
Publication history
Published online: April 23, 2019
Accepted:
April 10,
2019
Received:
September 13,
2018
Footnotes
See editorial by Lee and Parkash, pages 1091–1093 of this issue.
See page 1156 for disclosure information.
Identification
Copyright
© 2019 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
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- Left Atrial Function and Sudden Cardiac DeathCanadian Journal of CardiologyVol. 35Issue 9
- PreviewSudden cardiac death (SCD), presumed to be due to a cardiac arrhythmia or haemodynamic catastrophe, is defined as occurring within an hour of the onset of symptoms, or as an unwitnessed death occurring within 24 hours of being asymptomatic.1 The incidence of SCD in the general population internationally ranges from 50 to 100 per 100,000 persons per year.2 Approaches to the prevention of SCD may be divided into 2 categories: the prevention of the conditions leading to SCD, and the identification of those at increased risk of SCD followed by their treatment with interventions to reduce that risk.
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