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Reunião Anual Conjunta dos Grupos de Estudo de Cirurgia Cardíaca, Doenças Valvulares e Ecocardiografia da SPC
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Using the 3D architecture of scar to predict life-threatening ventricular arrhythmias – still a long way to go
Session:
Comunicações Orais - Sessão 13 - Taquicardia Ventricular e Morte Súbita Cardíaca
Speaker:
Rita Amador
Congress:
CPC 2023
Topic:
C. Arrhythmias and Device Therapy
Theme:
08. Ventricular Arrhythmias and Sudden Cardiac Death (SCD)
Subtheme:
08.7 Ventricular Arrhythmias and SCD - Other
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Rita R. Amador; Ana Rita Bello; Pedro Freitas; Sara Guerreiro; João Abecasis; Ana Coutinho Santos; Carla Saraiva; Pedro Galvão Santos; Francisco Moscoso Costa; Maria Salomé Carvalho; Pedro Carmo; Diogo Cavaco; Francisco Morgado; António Miguel Ferreira; Pedro Adragão
Abstract
<p style="text-align:justify"><u><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif">Background</span></span></u><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif">: </span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Late gadolinium enhancement (LGE) has been proposed as an independent predictor of ventricular arrhythmias. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><u>Purpose</u>: The purpose of this study was to assess if myocardial scar characterization could enhance the risk stratification for life-threatening arrhythmias and sudden cardiac death (SCD).</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><u>Methods</u><span style="color:#222222">: We included patients with an indication for ICD or CRT-D implantation who underwent cardiac magnetic resonance for clinical proposes since February/2018 and in whom a 3D-LGE dataset was obtained. Patients with channelopathies (n=2) or inappropriate imaging quality (imaging artifacts; n=7) were excluded. Scar characterization using ADAS software was performed in 3D-LGE datasets in all but 5 patients, where 2D datasets were used. The primary endpoint was the composite of appropriate ICD therapy (classified as ATP or shock) or SCD.</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><u><span style="color:#222222">Results</span></u><span style="color:#222222">: A total of 116 patients were analysed (mean age 66 ± 14 years; 81% male; mean LVEF 34 ± 14%; </span><span style="color:black">74</span><span style="color:#222222"> patients with ischemic and </span><span style="color:black">42 </span><span style="color:#222222">with non-ischemic cardiomyopathy; 40 patients received a device in the setting of secondary prevention). </span><span style="color:black">During a median follow-up of 2.3 years (IQR 1.3 – 3.3 years)</span> <span style="color:black">there </span>were 23 events (18 appropriate ICD therapies [9 shocks and 9 ATP], 3 episodes of VT under the threshold for ICD therapy and 2 SCD). No statistically significant differences were found between patients with or without events in terms of scar mass, border zone (BZ) mass, BZ channels (BZC), BZC mass, number of channels detected, and scar heterogeneity (BZ mass / scar mass ratio) - all p values > 0.2 – Figure. Restricting the analysis to only primary prevention cases yielded similar results. Overall, 26 patients did not show any channel. Four of these experienced an arrhythmic event, yielding a negative predictive value of 83% (95% CI 64-93%) for the absence of channels. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="background-color:white"><span style="font-family:Calibri,sans-serif"><u><span style="color:#222222">Conclusion</span></u><span style="color:#222222">: In this cohort with still relatively limited follow-up duration, no single parameter reflecting scar tissue characterization was able to predict appropriate device therapies or sudden cardiac death. </span></span></span></span></p>
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