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Xiang C, Zhang H, Li H, Zhou X, Huang L, Xia L. The value of cardiac magnetic resonance post-contrast T1 mapping in improving the evaluation of myocardial infarction. Front Cardiovasc Med 2023; 10:1238451. [PMID: 37908503 PMCID: PMC10613640 DOI: 10.3389/fcvm.2023.1238451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 10/05/2023] [Indexed: 11/02/2023] Open
Abstract
Objective To explore the additional value of cardiac magnetic resonance (CMR) post-contrast T1 mapping in the detection of myocardial infarction, compared with late gadolinium enhancement (LGE). Materials and methods A CMR database of consecutive patients with myocardial infarction was retrospectively analyzed. All patients were scanned at 3 T magnetic resonance; they underwent conventional CMR (including LGE) and post-contrast T1 mapping imaging. Two radiologists interpreted the CMR images using a 16-segment model. The first interpretation included only LGE images. After 30 days, the same radiologists performed a second analysis of random LGE images, with the addition of post-contrast T1 mapping images. Images were analyzed to diagnose myocardial scars, and the transmural extent of each scar was visually evaluated. Diagnoses retained after LGE were compared with diagnoses retained after the addition of post-contrast T1 mapping. Results In total, 80 patients (1,280 myocardial segments) were included in the final analysis. After the addition of post-contrast T1 mapping, eight previously unidentified subendocardial scars were detected. Compared with LGE images, the percentage of infarcted segments was higher after the addition of post-contrast T1 mapping images (21.7% vs. 22.3%, P = 0.008), the percentage of uncertain segments was lower after the addition of post-contrast T1 mapping (0.8% vs. 0.1%, P = 0.004), and the percentage of uncertain transmural extent of scarring was lower after the addition of post-contrast T1 mapping (0.9% vs. 0.1%, P = 0.001). Conclusion The addition of post-contrast T1 mapping after LGE helps to improve the detection of myocardial infarction, as well as the assessment of the transmural extent of scarring.
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Affiliation(s)
- Chunlin Xiang
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hongyan Zhang
- Department of Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Haojie Li
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaoyue Zhou
- Siemens Healthineers Digital Technology (Shanghai) Co., Ltd., Shanghai, China
| | - Lu Huang
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Liming Xia
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Younis A, Wilkoff BL. Implantable Cardioverter-Defibrillator for Primary Prevention in Asia. JACC. ASIA 2023; 3:321-334. [PMID: 37323870 PMCID: PMC10261897 DOI: 10.1016/j.jacasi.2022.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 11/16/2022] [Accepted: 11/24/2022] [Indexed: 06/17/2023]
Abstract
In a contemporary setting, where the risk of sudden cardiac death (SCD) is low, heart failure management is improved, and technology is advanced, identifying the patients who would benefit the most from an implantable cardioverter-defibrillator (ICD) treatment for primary prevention remains a challenge. The prevalence of SCD is lower in Asia when compared with the United States/Europe (35-45 per 100,000 person-years vs 55-100 per 100,000 person-years, respectively). Nevertheless, this should not explain the enormous gap in ICD's utilization among eligible candidates (∼12% in Asia vs ∼45% in the United States/Europe). The disparity between Asia and Western countries, together with significant variation among the Asian population and the previously mentioned challenges, requires an individualized approach and specific regional recommendation, especially in countries with limited resources where ICDs are being extremely underutilized This review focuses on the current knowledge of ICD therapy for SCD prevention and how to improve patient and device selection.
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Affiliation(s)
| | - Bruce L. Wilkoff
- Address for correspondence: Dr Bruce L. Wilkoff, Department of Cardiovascular Medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, 9500 Euclid Avenue, Desk J2-2, Cleveland, Ohio 44195, USA. @BruceWilkoff
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Tsimos KP, Korantzopoulos P, Arsenos P, Doundoulakis I, Tsiachris D, Antoniou CK, Krikonis K, Sideris S, Dilaveris P, Triantafyllou K, Soulaidopoulos S, Kanoupakis E, Fragakis N, Sideris A, Trachanas K, Iliodromitis E, Tousoulis D, Tsioufis K, Kolettis TM, Gatzoulis KA. Association of non-invasive electrocardiographic risk factors with left ventricular systolic function in post-myocardial infarction patients with mildly reduced or preserved ejection fraction: Insights from the PRESERVE-EF study. Ann Noninvasive Electrocardiol 2022; 27:e12946. [PMID: 35795926 PMCID: PMC9484020 DOI: 10.1111/anec.12946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 02/09/2022] [Accepted: 02/10/2022] [Indexed: 11/28/2022] Open
Abstract
Background Electrocardiographic non‐invasive risk factors (NIRFs) have an important role in the arrhythmic risk stratification of post‐myocardial infarction (post‐MI) patients with preserved or mildly reduced left ventricular ejection fraction (LVEF). However, their specific relation to left ventricular systolic function remains unclear. We aimed to evaluate the association between NIRFs and LVEF in the patients included in the PRESERVE‐EF trial. Methods We studied 575 post‐MI ischemia‐free patients with LVEF≥40% (mean age: 57.0 ± 10.4 years, 86.2% men). The following NIRFs were evaluated: premature ventricular complexes, non‐sustained ventricular tachycardia (NSVT), late potentials (LPs), prolonged QTc, increased T‐wave alternans, reduced heart rate variability, and abnormal deceleration capacity with abnormal turbulence. Results There was a statistically significant relationship between LPs (Chi‐squared = 4.975; p < .05), nsVT (Chi‐squared = 5.749, p < .05), PVCs (r= −.136; p < .01), and the LVEF. The multivariate linear regression analysis showed that LPs (p = .001) and NSVT (p < .001) were significant predictors of the LVEF. The results of the multivariate logistic regression analysis indicated that LPs (OR: 1.76; 95% CI: 1.02–3.05; p = .004) and NSVT (OR: 2.44; 95% CI: 1.18–5.04; p = .001) were independent predictors of the mildly reduced LVEF: 40%–49% versus the preserved LVEF: ≥50%. Conclusion Late potentials and NSVT are independently related to reduced LVEF while they are independent predictors of mildly reduced LVEF versus the preserved LVEF. These findings may have important implications for the arrhythmic risk stratification of post‐MI patients with mildly reduced or preserved LVEF.
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Affiliation(s)
- Konstantinos P Tsimos
- First Department of Cardiology, University of Ioannina Medical School, Ioannina, Greece
| | | | - Petros Arsenos
- First Department of Cardiology, Hippokrateion Hospital, National and Kapodistrian University of Athens, Athens, Greece.,Arsenos Heart & Biosignals Lab, Avlonas, Greece
| | - Ioannis Doundoulakis
- First Department of Cardiology, Hippokrateion Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Tsiachris
- First Department of Cardiology, Hippokrateion Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | | | | | - Skevos Sideris
- State Department of Cardiology, Hippokrateion General Hospital, Athens, Greece
| | - Polychronis Dilaveris
- First Department of Cardiology, Hippokrateion Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Stergios Soulaidopoulos
- First Department of Cardiology, Hippokrateion Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Emmanuel Kanoupakis
- Department of Cardiology, School of Medicine, Heraklion University Hospital, University of Crete, Heraklion, Greece
| | - Nikolaos Fragakis
- Third Department of Cardiology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Antonios Sideris
- Second State Department of Cardiology, Evangelismos Athens General Hospital, Athens, Greece
| | | | - Efstathios Iliodromitis
- Second Cardiology Department, Attikon Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Tousoulis
- First Department of Cardiology, Hippokrateion Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos Tsioufis
- First Department of Cardiology, Hippokrateion Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Theofilos M Kolettis
- First Department of Cardiology, University of Ioannina Medical School, Ioannina, Greece
| | - Konstantinos A Gatzoulis
- First Department of Cardiology, Hippokrateion Hospital, National and Kapodistrian University of Athens, Athens, Greece
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4
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Trachanas K, Sideris S, Arsenos P, Tsiachris D, Antoniou CK, Dilaveris P, Triantafyllou K, Xenogiannis I, Tsimos K, Efremidis M, Kanoupakis E, Flevari P, Vassilikos V, Sideris A, Korantzopoulos P, Tousoulis D, Tsioufis K, Gatzoulis K. Noninvasive risk factors for the prediction of inducibility on programmed ventricular stimulation in post-myocardial infarction patients with an ejection fraction ≥40% at risk for sudden cardiac arrest: Insights from the PRESERVE-EF study. Ann Noninvasive Electrocardiol 2021; 27:e12908. [PMID: 34873786 PMCID: PMC8916556 DOI: 10.1111/anec.12908] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 10/05/2021] [Accepted: 10/11/2021] [Indexed: 11/29/2022] Open
Abstract
Background In the PRESERVE‐EF study, a two‐step sudden cardiac death (SCD) risk stratification approach to detect post‐myocardial infarction (MI) patients with left ventricle ejection fraction (LVEF) ≥40% at risk for major arrhythmic events (MAEs) was used. Seven noninvasive risk factors (NIRFs) were extracted from a 24‐h ambulatory electrocardiography (AECG) and a 45‐min resting recording. Patients with at least one NIRF present were referred for invasive programmed ventricular stimulation (PVS) and inducible patients received an Implantable Cardioverter ‐ Defibrillator (ICD). Methods In the present study, we evaluated the performance of the NIRFs, as they were described in the PRESERVE‐EF study protocol, in predicting a positive PVS. In the PRESERVE‐EF study, 152 out of 575 patients underwent PVS and 41 of them were inducible. For the present analysis, data from these 152 patients were analyzed. Results Among the NIRFs examined, the presence of signal averaged ECG‐late potentials (SAECG‐LPs) ≥ 2/3 and non‐sustained ventricular tachycardia (NSVT) ≥1 eposode/24 h cutoff points were important predictors of a positive PVS study, demonstrating in the logistic regression analysis odds ratios 2.285 (p = .027) and 2.867 (p = .006), respectively. A simple risk score based on the above cutoff points in combination with LVEF < 50% presented high sensitivity but low specificity for a positive PVS. Conclusion Cutoff points of NSVT ≥ 1 episode/24 h and SAECG‐LPs ≥ 2/3 in combination with a LVEF < 50% were important predictors of inducibility. However, the final decision for an ICD implantation should be based on a positive PVS, which is irreplaceable in risk stratification.
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Affiliation(s)
| | - Skevos Sideris
- State Department of Cardiology, Hippokrateion General Hospital, Athens, Greece
| | - Petros Arsenos
- First Department of Cardiology, Hippokrateion General Hospital, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | - Dimitrios Tsiachris
- First Department of Cardiology, Hippokrateion General Hospital, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | - Christos-Konstantinos Antoniou
- First Department of Cardiology, Hippokrateion General Hospital, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | - Polychronis Dilaveris
- First Department of Cardiology, Hippokrateion General Hospital, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | | | - Iosif Xenogiannis
- Second Department of Cardiology, Attikon General Hospital, National and Kapodistrian University of Athens School of Medicine, Chaidari, Greece
| | - Konstantinos Tsimos
- Department of Cardiology, Faculty of Medicine, University of Ioannina, Ioannina, Greece
| | - Michalis Efremidis
- Second State Department of Cardiology, Evangelismos Athens General Hospital, Athens, Greece
| | - Emmanuel Kanoupakis
- Department of Cardiology, Heraklion University Hospital, University of Crete, School of Medicine, Heraklion, Greece
| | - Panagiota Flevari
- Second Department of Cardiology, Attikon General Hospital, National and Kapodistrian University of Athens School of Medicine, Chaidari, Greece
| | - Vassilios Vassilikos
- Third Department of Cardiology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Antonios Sideris
- Second State Department of Cardiology, Evangelismos Athens General Hospital, Athens, Greece
| | | | - Dimitrios Tousoulis
- First Department of Cardiology, Hippokrateion General Hospital, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | - Konstantinos Tsioufis
- First Department of Cardiology, Hippokrateion General Hospital, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | - Konstantinos Gatzoulis
- First Department of Cardiology, Hippokrateion General Hospital, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
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5
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Karaayvaz EB, Engin B, Yalin K, Ozer PK, Baykiz D, Bilge AK. Association between integrated backscatter and arrhythmia in patients with ischemic dilated cardiomyopathy. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2021; 44:1010-1017. [PMID: 33969900 DOI: 10.1111/pace.14257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 03/30/2021] [Accepted: 05/02/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Ventricular scars due to myocardial infarction provide a substrate for ventricular arrhythmias, and cardiac magnetic resonance (CMR) is the golden standard for the quantification of scar tissue magnitude. CMR has still limitations with patients with ICD despite ICD's becoming MR-compatible. We investigated the association between calibrated integrated backscatter (cIBS) and arrhythmia frequency in patients with ICD. METHODS Thirty-two ischemic dilated cardiomyopathy (ICM) patients with VVI-ICD (mean age 66.56 ± 9.05, 28 male, and four female) were divided into three groups according to their arrhythmia frequency (ventricular arrhythmia-[VA -], VA + [VA +], and arrhythmia storm [AS]). Then with transthoracic echocardiography (TTE), all patients' cIBS values were calculated and these values were compared with the patients' arrhythmia frequency. RESULTS cIBS values of patients with VA + and AS were significantly higher in the apical-septal (0.66 ± 0.11 vs. 0.50 ± 0.16, p = .008) and apical-lateral (0.62 ± 0.19 vs. 0.46 ± 0.18, p = .041) segments compared to those of patients with VA -. The cIBS values of apical-septal (0.50 ± 0.16 vs. 0.65 ± 0.08 vs. 0.66 ± 0.13 respectively, p = .032) and apical-anterior (0.53 ± 0.22 vs. 0.48 ± 0.17 vs. 0.79 ± 0.23 respectively, p = .03) segments were significantly different between the groups. Furthermore, in the post hoc analysis, the difference was significantly higher in VA + than VA - in the apical-septal segment and higher in AS than VA + in apical-anterior segments. CONCLUSION Our findings suggest an association between the cIBS values and arrhythmia frequency in the study group.
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Affiliation(s)
- Ekrem Bilal Karaayvaz
- Department of Cardiology, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
| | | | - Kivanc Yalin
- Department of Cardiology, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Pelin Karaca Ozer
- Department of Cardiology, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Derya Baykiz
- Department of Cardiology, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Ahmet Kaya Bilge
- Department of Cardiology, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
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Primary Prevention Implantable Cardioverter-Defibrillator Therapy in Heart Failure with Recovered Ejection Fraction. J Card Fail 2021; 27:585-596. [PMID: 33636331 DOI: 10.1016/j.cardfail.2021.02.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 01/26/2021] [Accepted: 02/07/2021] [Indexed: 11/21/2022]
Abstract
Given recent advances in both pharmacologic and nonpharmacologic strategies for improving outcomes related to chronic systolic heart failure, heart failure with recovered ejection fraction (HFrecEF) is now recognized as a distinct clinical entity with increasing prevalence. In many patients who once had an indication for active implantable cardioverter-defibrillator (ICD) therapy, questions remain regarding the usefulness of this primary prevention strategy to protect against syncope and cardiac arrest after they have achieved myocardial recovery. Early, small studies provide convincing evidence for continued guideline-directed medical therapy (GDMT) in segments of the HFrecEF population to promote persistent left ventricular myocardial recovery. Retrospective data suggest that the risk of sudden cardiac death is lower, but still present, in HFrecEF as compared with HF with reduced ejection fraction, with reports of up to 5 appropriate ICD therapies delivered per 100 patient-years. The usefulness of continued ICD therapy is weighed against the unfavorable effects of this strategy, which include a cumulative risk of infection, inappropriate discharge, and patient-level anxiety. Historically, many surrogate measures for risk stratification have been explored, but few have demonstrated efficacy and widespread availability. We found that the available data to inform decisions surrounding the continued use of active ICD therapies in this population are incomplete, and more advanced tools such as genetic testing, evaluation of high-risk structural cardiomyopathies (such as noncompaction), and cardiac magnetic resonance imaging have emerged as vital in risk stratification. Clinicians and patients should engage in shared decision-making to evaluate the appropriateness of active ICD therapy for any given individual. In this article, we explore the definition of HFrecEF, data underlying continuation of guideline-directed medical therapy in patients who have achieved left ventricular ejection fraction recovery, the benefits and risks of active ICD therapy, and surrogate measures that may have a role in risk stratification.
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7
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Gatzoulis KA, Tsiachris D, Arsenos P, Antoniou CK, Dilaveris P, Sideris S, Kanoupakis E, Simantirakis E, Korantzopoulos P, Goudevenos I, Flevari P, Iliodromitis E, Sideris A, Vassilikos V, Fragakis N, Trachanas K, Vernardos M, Konstantinou I, Tsimos K, Xenogiannis I, Vlachos K, Saplaouras A, Triantafyllou K, Kallikazaros I, Tousoulis D. Arrhythmic risk stratification in post-myocardial infarction patients with preserved ejection fraction: the PRESERVE EF study. Eur Heart J 2020; 40:2940-2949. [PMID: 31049557 PMCID: PMC6748724 DOI: 10.1093/eurheartj/ehz260] [Citation(s) in RCA: 76] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Revised: 12/26/2018] [Accepted: 04/10/2019] [Indexed: 12/13/2022] Open
Abstract
Aims Sudden cardiac death (SCD) annual incidence is 0.6–1% in post-myocardial infarction (MI) patients with left ventricular ejection fraction (LVEF)≥40%. No recommendations for implantable cardioverter-defibrillator (ICD) use exist in this population. Methods and results We introduced a combined non-invasive/invasive risk stratification approach in post-MI ischaemia-free patients, with LVEF ≥ 40%, in a multicentre, prospective, observational cohort study. Patients with at least one positive electrocardiographic non-invasive risk factor (NIRF): premature ventricular complexes, non-sustained ventricular tachycardia, late potentials, prolonged QTc, increased T-wave alternans, reduced heart rate variability, abnormal deceleration capacity with abnormal turbulence, were referred for programmed ventricular stimulation (PVS), with ICDs offered to those inducible. The primary endpoint was the occurrence of a major arrhythmic event (MAE), namely sustained ventricular tachycardia/fibrillation, appropriate ICD activation or SCD. We screened and included 575 consecutive patients (mean age 57 years, LVEF 50.8%). Of them, 204 (35.5%) had at least one positive NIRF. Forty-one of 152 patients undergoing PVS (27–7.1% of total sample) were inducible. Thirty-seven (90.2%) of them received an ICD. Mean follow-up was 32 months and no SCDs were observed, while 9 ICDs (1.57% of total screened population) were appropriately activated. None patient without NIRFs or with NIRFs but negative PVS met the primary endpoint. The algorithm yielded the following: sensitivity 100%, specificity 93.8%, positive predictive value 22%, and negative predictive value 100%. Conclusion The two-step approach of the PRESERVE EF study detects a subpopulation of post-MI patients with preserved LVEF at risk for MAEs that can be effectively addressed with an ICD. Clinicaltrials.gov identifier NCT02124018 ![]()
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Affiliation(s)
- Konstantinos A Gatzoulis
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokrateion Hospital, 114 Vasilissis Sofias avenue, Athens, Attica, Greece
| | - Dimitrios Tsiachris
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokrateion Hospital, 114 Vasilissis Sofias avenue, Athens, Attica, Greece
| | - Petros Arsenos
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokrateion Hospital, 114 Vasilissis Sofias avenue, Athens, Attica, Greece
| | - Christos-Konstantinos Antoniou
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokrateion Hospital, 114 Vasilissis Sofias avenue, Athens, Attica, Greece
| | - Polychronis Dilaveris
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokrateion Hospital, 114 Vasilissis Sofias avenue, Athens, Attica, Greece
| | - Skevos Sideris
- State Department of Cardiology, Hippokrateion Hospital, 114 Vasilissis Sofias avenue, Athens, Attica, Greece
| | - Emmanuel Kanoupakis
- Department of Cardiology, University Hospital of Heraklion, University of Crete, Panepistimiou street, Heraklion, Crete, Greece
| | - Emmanouil Simantirakis
- Department of Cardiology, University Hospital of Heraklion, University of Crete, Panepistimiou street, Heraklion, Crete, Greece
| | - Panagiotis Korantzopoulos
- First Cardiology Division, University Hospital of Ioannina, University of Ioannina, Stavros Niarchos avenue, Ioannina, Epirus, Greece
| | - Ioannis Goudevenos
- First Cardiology Division, University Hospital of Ioannina, University of Ioannina, Stavros Niarchos avenue, Ioannina, Epirus, Greece
| | - Panagiota Flevari
- Second Cardiology Department, National and Kapodistrian University of Athens, Attikon Hospital, 1 Rimini street, Chaidari, Attica, Greece
| | - Efstathios Iliodromitis
- Second Cardiology Department, National and Kapodistrian University of Athens, Attikon Hospital, 1 Rimini street, Chaidari, Attica, Greece
| | - Antonios Sideris
- Second State Cardiology Department, Evangelismos Hospital, 45-47 Ipsilantou street, Athens, Attica, Greece
| | - Vassilios Vassilikos
- Third Cardiology Department, Aristotle University Medical School, Hippokrateion Hospital, 49 Konstantinoupoleos street, Thessaloniki, Macedonia, Greece
| | - Nikolaos Fragakis
- Third Cardiology Department, Aristotle University Medical School, Hippokrateion Hospital, 49 Konstantinoupoleos street, Thessaloniki, Macedonia, Greece
| | - Konstantinos Trachanas
- State Department of Cardiology, Hippokrateion Hospital, 114 Vasilissis Sofias avenue, Athens, Attica, Greece
| | - Michail Vernardos
- Department of Cardiology, University Hospital of Heraklion, University of Crete, Panepistimiou street, Heraklion, Crete, Greece
| | - Ioannis Konstantinou
- Department of Cardiology, University Hospital of Heraklion, University of Crete, Panepistimiou street, Heraklion, Crete, Greece
| | - Konstantinos Tsimos
- First Cardiology Division, University Hospital of Ioannina, University of Ioannina, Stavros Niarchos avenue, Ioannina, Epirus, Greece
| | - Iosif Xenogiannis
- Second Cardiology Department, National and Kapodistrian University of Athens, Attikon Hospital, 1 Rimini street, Chaidari, Attica, Greece
| | - Konstantinos Vlachos
- Second State Cardiology Department, Evangelismos Hospital, 45-47 Ipsilantou street, Athens, Attica, Greece
| | - Athanasios Saplaouras
- Second State Cardiology Department, Evangelismos Hospital, 45-47 Ipsilantou street, Athens, Attica, Greece
| | - Konstantinos Triantafyllou
- Third Cardiology Department, Aristotle University Medical School, Hippokrateion Hospital, 49 Konstantinoupoleos street, Thessaloniki, Macedonia, Greece
| | - Ioannis Kallikazaros
- State Department of Cardiology, Hippokrateion Hospital, 114 Vasilissis Sofias avenue, Athens, Attica, Greece
| | - Dimitrios Tousoulis
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokrateion Hospital, 114 Vasilissis Sofias avenue, Athens, Attica, Greece
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Yalin K, Liosis S, Palade E, Fink T, Schierholz S, Sawan N, Eitel C, Heeger CH, Sciacca V, Sano M, Vogler J, Tilz RR. Cardiac sympathetic denervation in patients with nonischemic cardiomyopathy and refractory ventricular arrhythmias: a single-center experience. Clin Res Cardiol 2020; 110:21-28. [PMID: 32328735 DOI: 10.1007/s00392-020-01643-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 04/03/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Cardiac sympathetic denervation (CSD) is an effective therapy for selected patients with drug refractory ventricular arrhythmias (VA). Data about the role of CSD in patients with structural heart disease and VAs are sparse. We herein present our experience of CSD in patients with nonischemic cardiomyopathy and VAs despite prior ablation procedure and/or antiarrhythmic drug (AAD) therapy. METHODS A total of ten patients (mean age 61.6 ± 19.6, mean LVEF 29.5 ± 12.1%) with nonischemic dilated cardiomyopathy (NICM) (n = 9) and hypertrophic cardiomyopathy (HCM) (n = 1) underwent CSD (left sided in six and bilateral in four patients) due to refractory VA despite multiple AADs (mean number of AADs was 1.6 ± 0.7) and prior VT ablation (mean number of procedures per patient was 1.5 ± 1.3). RESULTS Mean follow-up was 10.1 ± 6.9 months. The median number of VA and ICD shocks decreased significantly from 9.0 and 2.5 episodes 6 months prior to CSD to 0 and 0 episodes within 6 months after CSD (p = 0.012 and p = 0.011). Five patients remained free from sustained VA recurrences. Two patients experienced single ICD shock due to a polymorphic VT (triggered by severe hypokalemia in one patient) and one patient a single shock due to monomorphic VT. One patient had five episodes of slow VT under amiodarone therapy (three of them terminated by antitachycardia pacing) and underwent endo- epicardial re-ablation. Two patients died 1 month after CSD. One of them due to electrical storm and cardiogenic shock and the second one due to refractory cardiogenic shock, without recurrence of VAs though. No major complications of CSD occurred. No patient suffered from Horner syndrome. CONCLUSION In this study, CSD was effective for treatment of VAs in patients with structural heart disease refractory to antiarrhythmic drugs and catheter ablation. Further larger studies are required to confirm these findings.
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Affiliation(s)
- Kivanc Yalin
- Department of Cardiology, Angiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, University Heart Center Lübeck, Medical Clinic II, Lübeck, Germany. .,Cerrahpasa Faculty of Medicine, Department of Cardiology, Istanbul University-Cerrahpasa, Istanbul, Turkey.
| | - Spyridon Liosis
- Department of Cardiology, Angiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, University Heart Center Lübeck, Medical Clinic II, Lübeck, Germany
| | - Emanuel Palade
- Department of Surgery, Medical University of Schleswig-Holstein, Campus, Lübeck, Germany
| | - Thomas Fink
- Department of Cardiology, Angiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, University Heart Center Lübeck, Medical Clinic II, Lübeck, Germany
| | - Stefanie Schierholz
- Department of Surgery, Medical University of Schleswig-Holstein, Campus, Lübeck, Germany
| | - Noureddin Sawan
- Department of Cardiology, Angiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, University Heart Center Lübeck, Medical Clinic II, Lübeck, Germany
| | - Charlotte Eitel
- Department of Cardiology, Angiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, University Heart Center Lübeck, Medical Clinic II, Lübeck, Germany
| | - Christian H Heeger
- Department of Cardiology, Angiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, University Heart Center Lübeck, Medical Clinic II, Lübeck, Germany
| | - Vanessa Sciacca
- Department of Cardiology, Angiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, University Heart Center Lübeck, Medical Clinic II, Lübeck, Germany
| | - Makoto Sano
- Department of Cardiology, Angiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, University Heart Center Lübeck, Medical Clinic II, Lübeck, Germany
| | - Julia Vogler
- Department of Cardiology, Angiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, University Heart Center Lübeck, Medical Clinic II, Lübeck, Germany
| | - Roland Richard Tilz
- Department of Cardiology, Angiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, University Heart Center Lübeck, Medical Clinic II, Lübeck, Germany. .,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Luebeck, Lübeck, Germany.
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9
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Goldenberg I, Huang DT, Nielsen JC. The role of implantable cardioverter-defibrillators and sudden cardiac death prevention: indications, device selection, and outcome. Eur Heart J 2019; 41:2003-2011. [DOI: 10.1093/eurheartj/ehz788] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 09/09/2019] [Accepted: 10/26/2019] [Indexed: 12/31/2022] Open
Abstract
Abstract
Multiple randomized multicentre clinical trials have established the role of the implantable cardioverter-defibrillator (ICD) as the mainstay in the treatment of ventricular tachyarrhythmias and sudden cardiac death (SCD) prevention. These trials have focused mainly on heart failure patients with advanced left ventricular dysfunction and were mostly conducted two decades ago, whereas a more recent trial has provided conflicting results. Therefore, much remains to be determined on how best to balance the identification of patients at high risk of SCD together with who would benefit most from ICD implantation in a contemporary setting. Implantable cardioverter-defibrillators have also evolved from the simple, defibrillation-only devices implanted surgically to more advanced technologies of multi-chamber devices, with physiologic bradycardic pacing, including cardiac resynchronization therapy, atrial and ventricular therapeutic pacing algorithms, and subcutaneous ICDs. These multiple options necessitate individualized approach to device selection and programming. This review will focus on the current knowledge on selection of patients for ICD treatment, device selection and programming, and future directions of implantable device therapy for SCD prevention.
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Affiliation(s)
- Ilan Goldenberg
- Division of Cardiology, Department of Medicine, The Clinical Cardiovascular Research Center, University of Rochester Medical Center, 265 Crittenden Blvd CU 420653, Rochester, NY 14642, USA
| | - David T Huang
- Division of Cardiology, Department of Medicine, The Clinical Cardiovascular Research Center, University of Rochester Medical Center, 265 Crittenden Blvd CU 420653, Rochester, NY 14642, USA
| | - Jens Cosedis Nielsen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
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10
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Haghbayan H, Lougheed N, Deva DP, Chan KK, Lima JA, Yan AT. Peri-Infarct Quantification by Cardiac Magnetic Resonance to Predict Outcomes in Ischemic Cardiomyopathy. Circ Cardiovasc Imaging 2019; 12:e009156. [DOI: 10.1161/circimaging.119.009156] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background:
In ischemic cardiomyopathy, cardiac magnetic resonance assessment of the peri-infarct zone, a potential substrate for arrhythmogenesis, may serve as a novel prognosticator and guide the optimal use of implantable cardioverter-defibrillators. We undertook a systematic review and meta-analysis assessing the prognostic value of the peri-infarct zone on late gadolinium enhancement cardiac magnetic resonance in ischemic cardiomyopathy.
Methods:
We searched MEDLINE (Medical Literature Analysis and Retrieval System Online), EMBASE (Medical Literature Analysis and Retrieval System Online), and CENTRAL (Medical Literature Analysis and Retrieval System Online) from inception to January 2019 for prognostic studies relating peri-infarct size with clinical outcomes in ischemic cardiomyopathy. Two authors independently performed study selection and data extraction. Pooled effect estimates were calculated with random effects models, risk of bias and strength of evidence were assessed by the Quality in Prognostic Studies tool and Grading of Recommendations Assessment, Development, and Education, respectively.
Results:
Twenty studies were eligible, representing 14 cohort studies (n=1518) with mean follow-up of 3.6 years and 6 cross-sectional studies (n=189). The extent of the peri-infarct zone was significantly predictive of all-cause mortality (3 studies; n=539; hazard ratio, 1.34/10 g [95% CI, 1.13–1.59];
I
2
=0%; high-quality evidence), appropriate implantable cardioverter-defibrillator therapy (5 studies; n=361; hazard ratio, 1.31/10 g [95% CI, 1.17–1.47];
I
2
=0%; high-quality evidence), and inducibility of ventricular tachycardia on electrophysiological study (5 studies; n=167; OR, 2.63/g [95% CI, 1.39–4.96];
I
2
=14%; low-quality evidence). After adjusting for age and left ventricular ejection fraction, the peri-infarct zone, as a percentage of total infarct size, remained an independent predictor of all-cause mortality (2 studies; n=445; hazard ratio, 1.29/10% [95% CI, 1.15–1.44];
I
2
=0%; high-quality evidence).
Conclusions:
There is limited but consistent evidence that quantification of the peri-infarct zone predicts long-term mortality and appropriate implantable cardioverter-defibrillator therapy in ischemic cardiomyopathy. Future studies should confirm whether late gadolinium enhancement-cardiac magnetic resonance assessment may improve implantable cardioverter-defibrillator treatment decisions.
Clinical Trial Registration:
URL:
https://www.crd.york.ac.uk/prospero/
. Unique identifier: CRD42017077337.
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Affiliation(s)
- Hourmazd Haghbayan
- Department of Medicine (H.H), University of Toronto, ON, Canada
- Department of Social and Preventive Medicine, Université Laval, QC, Canada (H.H.)
| | - Nick Lougheed
- Royal Victoria Regional Health Centre, Barrie, Canada (N.L.)
| | - Djeven P. Deva
- Department of Medical Imaging, St. Michael’s Hospital, Toronto, ON, Canada (D.P.D.)
| | - Kelvin K.W. Chan
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada (K.K.W.C.)
- Canadian Centre for Applied Research in Cancer Control, Toronto, ON, Canada (K.K.W.C.)
| | - João A.C. Lima
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD (J.A.C.L.)
| | - Andrew T. Yan
- Terrence Donnelly Heart Centre, St. Michael’s Hospital (A.T.Y.), University of Toronto, ON, Canada
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11
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Guler TE, Yalin K, Aksu T, Golcuk E, Sanli S, Kaya Bilge A, Adalet K. Prognostic value role of radiofrequency lesion size by cardiac magnetic resonance imaging on outcomes of ablation in patients with ischemic scar-related ventricular tachycardia: A single center pilot study. Medicine (Baltimore) 2018; 97:e12955. [PMID: 30431569 PMCID: PMC6257390 DOI: 10.1097/md.0000000000012955] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Inadequate ablation lesion formation may be responsible for post-ablation ventricular tachycardia (VT) recurrences.We aimed to evaluate whether visualisation of radiofrequency (RF) lesion size by cardiac magnetic resonance imaging (CMR) has any role in predicting adequacy of lesion and in estimating outcome.Retrospective pilot studyNine consecutive patients (8 male, age 60 ± 13 years) underwent ablation for sustained VT because of ischemic scar were evaluated for pre- and post-procedure scar tissue by CMR to characterize ablation lesions. Microvascular obstruction (MVO) surrounded by late gadolinium enhancement was defined as irreversible RF lesion. All patients were followed for at least 6 months for recurrences.Five of the patients had previous inferior myocardial infarction (MI), whereas remaining 4 had anterior MI. Acute procedural success, as defined by termination of the arrhythmia without recurrence in 30 minutes, was attained in all patients. Contrast enhancement and wall motion abnormality in presumed infarction area were confirmed by pre-ablation CMR images. MVO was detected at the reported ablation site in 6/9 patients, all arrhythmia- and symptom-free at median 24 months (range 8-38 months) follow-up. In remaining 3 patients who had VT recurrence (clinical VT in 2, sustain VT with a new morphology in 1), MVO was not detected despite achievement of acute procedural success. There was no correlation with pre-ablation scar size and clinical arrhythmia recurrence.CMR is a useful imaging modality to guide ablation procedures by detecting scar tissue. Additionally MVO seen by post-procedural imaging may be related to adequacy of RF ablation lesions and may correlate with clinical outcome.
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Affiliation(s)
- Tümer Erdem Guler
- University of Health Sciences, Kocaeli Derince Education and Research Hospital, Department of Cardiology, Kocaeli
| | - Kivanç Yalin
- Usak University, Faculty of Medicine, Department of Cardiology, Usak
| | - Tolga Aksu
- University of Health Sciences, Kocaeli Derince Education and Research Hospital, Department of Cardiology, Kocaeli
| | - Ebru Golcuk
- Balikesir University, Faculty of Medicine, Department of Cardiology, Balikesir
| | | | - Ahmet Kaya Bilge
- Istanbul University, Istanbul Faculty of Medicine, Department of Cardiology, Istanbul, Turkey
| | - Kamil Adalet
- Istanbul University, Istanbul Faculty of Medicine, Department of Cardiology, Istanbul, Turkey
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12
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Yalin K, Gölcük E. Frequent Premature Ventricular Contractions and Cardiomyopathy, Chicken and Egg situation. J Atr Fibrillation 2017; 10:1674. [PMID: 29250239 DOI: 10.4022/jafib.1674] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 08/28/2017] [Accepted: 08/30/2017] [Indexed: 11/10/2022]
Abstract
Premature ventricular contractions (PVCs) are usually regarded as benign in the absence of structural heart disease. However, frequent PVCs can lead to depressed LV function, called PVC-induced cardiomyopathy and can be reversible after suppression of PVCs. On the other hand, PVCs can be a part of underlying structural heart disease and may be linked to increased risk of sudden death. In this work, we reviewed the current literature on PVC-induced cardiomyopathy based on a case presentation.
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Affiliation(s)
- Kıvanç Yalin
- Usak Unisersity, Faculty of Medicine, Department of Cardiology, Usak-Turkey
| | - Ebru Gölcük
- Balikesir University, Faculty of Medicine, Department of Cardiology, Balikesir-Turkey
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13
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Bucciarelli-Ducci C, Baritussio A, Auricchio A. Cardiac MRI Anatomy and Function as a Substrate for Arrhythmias. Europace 2017; 18:iv130-iv135. [PMID: 28011840 DOI: 10.1093/europace/euw357] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 08/15/2016] [Indexed: 12/12/2022] Open
Abstract
The use of cardiovascular magnetic resonance (CMR) has been implemented in the diagnostic work-up of patients with cardiomyopathies by providing an accurate assessment of biventricular volumes and function and a detailed myocardial tissue characterization in a one-stop-shop multi-parametric imaging technique. Its unique capability to perform an accurate tissue characterization of the myocardium, which is superior to other imaging modalities, has prompt its use in the analysis of myocardial arrhythmic substrates and in the prognostic risk stratification of patients. Although left ventricular ejection fraction (LVEF) has always been the best-known predictor of arrhythmic risk, the quantification of myocardial scar by CMR has been recognised as a powerful risk stratification tool, independent of LVEF. Moreover, due to its ability to identify myocardial arrhythmic substrate, both ventricular but more recently also atrial, CMR is increasingly offered as a guide to ablation procedures.
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Affiliation(s)
- Chiara Bucciarelli-Ducci
- Bristol Heart Institute, Bristol NIHR Cardiovascular Biomedical Research Unit (BRU), University of Bristol, Bristol, Upper Maudlin Street, BS2 8HW, UK .,Fondazione Cardiocentro Ticino, Via Tesserete 48, 6900 Lugano, Switzerland
| | - Anna Baritussio
- Bristol Heart Institute, Bristol NIHR Cardiovascular Biomedical Research Unit (BRU), University of Bristol, Bristol, Upper Maudlin Street, BS2 8HW, UK
| | - Angelo Auricchio
- Fondazione Cardiocentro Ticino, Via Tesserete 48, 6900 Lugano, Switzerland
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14
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Role of cardiovascular magnetic resonance in acute and chronic ischemic heart disease. Int J Cardiovasc Imaging 2017; 34:67-80. [PMID: 28315985 PMCID: PMC5797568 DOI: 10.1007/s10554-017-1116-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 03/09/2017] [Indexed: 12/13/2022]
Abstract
Cardiovascular magnetic resonance (CMR) is a multi-parametric, multi-planar, non-invasive imaging technique, which allows accurate determination of biventricular function and precise myocardial tissue characterization in a one-stop-shop technique, free from the use of ionizing radiations. Though CMR has been increasingly applied over the last two decades in every-day clinical practice, its widest application has been in the assessment of ischemic cardiomyopathy.
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15
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Golcuk E, Yalin K, Aksu T, Tiryakioglu SK, Bilge AK, Adalet K. Peri-Infarction Zone as a Risk Marker for Patients With Postmyocardial Infarction. Am J Med Sci 2016; 351:452-8. [DOI: 10.1016/j.amjms.2016.01.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 11/03/2015] [Indexed: 11/24/2022]
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16
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Liew R. Sudden Cardiac Death Risk Stratification - An Update. Eur Cardiol 2015; 10:118-122. [PMID: 30310436 PMCID: PMC6159393 DOI: 10.15420/ecr.2015.10.2.118] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2015] [Accepted: 10/28/2015] [Indexed: 11/04/2022] Open
Abstract
Sudden cardiac death (SCD) remains a major public health problem worldwide, yet current methods to identify those at greatest risk are inadequate. High-risk individuals may benefit from potentially life-saving treatment, such as insertion of an implantable-cardioverter defibrillator (ICD). However, such treatments are expensive and have their own associated risks. Furthermore, most cases of SCD occur in the general adult population who may be relatively asymptomatic but yet have an underlying predisposition to SCD. Hence, there is great interest and clinical need in improving methods for risk stratification of SCD to identify those at greatest risk and implement the most appropriate treatment. This review provides an update on current risk-stratification methods for SCD in high-risk groups, in particular patients with reduced left ventricular function following acute myocardial infarction and those with non-ischaemic dilated cardiomyopathy, and highlights some novel methods that may have a role to play in future risk-stratification schemes. Approaches and challenges for SCD risk stratification among the general public are also discussed.
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Affiliation(s)
- Reginald Liew
- Gleneagles Hospital Singapore, Duke-NUS Graduate Medical School, Singapore
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17
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Yalin K, Golcuk E, Aksu T. Cardiac Magnetic Resonance for Ventricular Arrhythmia Therapies in Patients with Coronary Artery Disease. J Atr Fibrillation 2015; 8:1242. [PMID: 27957178 DOI: 10.4022/jafib.1242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Revised: 05/20/2015] [Accepted: 05/20/2015] [Indexed: 11/10/2022]
Abstract
Cardiac magnetic resonance (CMR) imaging is currently gold standard for myocardial tissue characterization and scar assessment. CMR serves potential prognostic information in patients with coronary artery disease (CAD) for both ventricular arrhythmia risk, as well as it may also be used for guiding VT ablation procedures. This review is focused on the usefulness of CMR for ventricular arrhythmia therapies in patients with CAD.
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Affiliation(s)
| | - Ebru Golcuk
- Derince Education and Research Hospital, Turkey
| | - Tolga Aksu
- Bursa State Hospital, Cardiology Clinic, Turkey
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18
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Nchimi A, Davin L, Georgiopoulos A, Lancellotti P. Value of cardiac MRI to evaluate ischemia-related ventricular arrhythmia substrates. Expert Rev Cardiovasc Ther 2015; 13:565-76. [DOI: 10.1586/14779072.2015.1030394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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19
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Yalin K, Golcuk E, Aksu T. CMR May Predict VT in ICM. How About in Better Hearts, Does It Really Work? PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2015; 38:775-6. [PMID: 25753431 DOI: 10.1111/pace.12621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Kivanc Yalin
- Bursa State Hospital, Cardiology, Clinic, Bursa, Turkey.
| | - Ebru Golcuk
- Department of Cardiology, Koç University, School of Medicine, Istanbul, Turkey
| | - Tolga Aksu
- Department of Cardiology Kocaeli Derince Research, Education Hospital, Kocaeli, Turkey
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20
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Yalin K, Golcuk E, Bilge AK, Aksu T, Buyukbayrak H, Tiryakioglu SK, Emet S, Adalet K. Combined analysis of unipolar and bipolar voltage mapping identifies recurrences after unmappable scar-related ventricular tachycardia ablation. Europace 2015; 17:1580-6. [PMID: 25750215 DOI: 10.1093/europace/euv013] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Accepted: 01/19/2015] [Indexed: 11/14/2022] Open
Abstract
AIMS Scars causing ventricular tachycardia can extend deep to and beyond bipolar low-voltage areas (LVAs) and they may be a reason for endocardial ablation failure. Analysis of endocardial unipolar voltage maps has been used to detect scar transmurality and epicardial scar. We hypothesized that endocardial unipolar LVA around the overlying bipolar LVA may predict endocardial ablation recurrence in patients with structural heart disease undergoing substrate modification. METHODS AND RESULTS Twenty consecutive patients with structural heart disease (11 ischaemic and 9 non-ischaemic cardiomyopathy) and undergoing substrate modification due to unmappable ventricular tachycardia (VT) (18 males, 51 ± 11 age, LVEF: 36 ± 7%) were retrospectively reviewed. Bipolar LVA defined as <1.5 mV and unipolar LVA defined as <8.3 mV, respectively, on electro-anatomic mapping system. Peripheral unipolar LVA (pUni-LVA) surrounding bipolar LVA was measured and compared patients with and without VT recurrence at 6-month follow-up period. : Mean unipolar voltage and mean bipolar voltage was 6.26 ± 4.99 and 1.90 ± 2.30 mV, respectively. Bipolar voltage and unipolar voltage in corresponding points were correlated (r = 0.652, P = 0.0001). In all patients, unipolar LVAs were larger than the bipolar LVAs. Bipolar LVA (91.1 ± 93.5 vs. 87.5 ± 47.5 cm(2), P = 0.91) and unipolar LVA (148.1 ± 96.3 vs. 104.7 ± 44.2 cm(2), P = 0.21) were similar in patients with and without VT recurrence, respectively. Peripheral unipolar LVA was significantly larger in patients with VT recurrence than without (57.0 ± 40.4 vs. 17.2 ± 12.9 cm(2), P = 0.01). CONCLUSION In patients with structural heart disease and unmappable VT, pUni-LVA surrounding bipolar scar predicts recurrence of VT ablation. The results of this pilot study highlight the importance of intramural/epicardial substrate on endocardial VT ablation outcome.
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Affiliation(s)
- Kivanc Yalin
- Department of Cardiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul Tıp Fakültesi-Fatih, Fatih, Istanbul 34104, Turkey Cardiology Clinic, Bursa State Hospital, Kliniği Osmangazi, Alaaddin Mh., Bursa 16040, Turkey
| | - Ebru Golcuk
- Department of Cardiology, School of Medicine, Koc University, Davutpaşa Cd. No:4 Topkapı, İstanbul, Turkey
| | - Ahmet Kaya Bilge
- Department of Cardiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul Tıp Fakültesi-Fatih, Fatih, Istanbul 34104, Turkey
| | - Tolga Aksu
- Department of Cardiology, Kocaeli Derice Research and Training Hospital, İbnisina Mh. Lojman Sk. Derince, Kocaeli, Turkey
| | | | - Selma Kenar Tiryakioglu
- Cardiology Clinic, Bursa State Hospital, Kliniği Osmangazi, Alaaddin Mh., Bursa 16040, Turkey
| | - Samim Emet
- Department of Cardiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul Tıp Fakültesi-Fatih, Fatih, Istanbul 34104, Turkey
| | - Kamil Adalet
- Department of Cardiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul Tıp Fakültesi-Fatih, Fatih, Istanbul 34104, Turkey
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