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Pontone G, Guaricci AI, Andreini D, Solbiati A, Guglielmo M, Mushtaq S, Baggiano A, Beltrama V, Fusini L, Rota C, Segurini C, Conte E, Gripari P, Dello Russo A, Moltrasio M, Tundo F, Lombardi F, Muscogiuri G, Lorenzoni V, Tondo C, Agostoni P, Bartorelli AL, Pepi M. Prognostic Benefit of Cardiac Magnetic Resonance Over Transthoracic Echocardiography for the Assessment of Ischemic and Nonischemic Dilated Cardiomyopathy Patients Referred for the Evaluation of Primary Prevention Implantable Cardioverter–Defibrillator Therapy. Circ Cardiovasc Imaging 2016; 9:CIRCIMAGING.115.004956. [DOI: 10.1161/circimaging.115.004956] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 08/05/2016] [Indexed: 01/03/2023]
Abstract
Background—
The aim of this study was to determine the prognostic benefit of cardiac magnetic resonance (CMR) over transthoracic echocardiography (TTE) in ischemic cardiomyopathy and nonischemic dilated cardiomyopathy patients evaluated for primary prevention implantable cardioverter–defibrillator therapy.
Methods and Results—
We enrolled 409 consecutive ischemic and dilated cardiomyopathy patients (mean age: 64±12 years; 331 men). All patients underwent TTE and CMR, and left ventricle end-diastolic volume, left ventricle end-systolic volume, and left ventricle ejection fraction (LVEF) were evaluated. In addition, late gadolinium enhancement was also assessed. All patients were followed up for major adverse cardiac events (MACE) defined as a composite end point of long runs of nonsustained ventricular tachycardia, sustained ventricular tachycardia, aborted sudden cardiac death, or sudden cardiac death. The median follow-up was 545 days. CMR showed higher left ventricle end-diastolic volume (mean difference: 43±22.5 mL), higher left ventricle end-systolic volume (mean difference: 34±20.5 mL), and lower LVEF (mean difference: −4.9±10%) as compared to TTE (
P
<0.01). MACE occurred in 103 (25%) patients. Patients experiencing MACE showed higher left ventricle end-diastolic volume, higher left ventricle end-systolic volume, and lower LVEF with both imaging modalities and higher late gadolinium enhancement per-patient prevalence as compared to patients without MACE. At multivariable analysis, CMR-LVEF ≤35% (hazard ratio=2.18 [1.3–3.8]) and the presence of late gadolinium enhancement (hazard ratio=2.2 [1.4–3.6]) were independently associated with MACE (
P
<0.01). A model based on CMR-LVEF ≤35% or CMR-LVEF ≤35% plus late gadolinium enhancement detection showed a higher performance in the prediction of MACE as compared to TTE-LVEF resulting in net reclassification improvement of 0.468 (95% confidence interval, 0.283–0.654;
P
<0.001) and 0.413 (95% confidence interval, 0.23–0.63;
P
<0.001), respectively.
Conclusions—
CMR provides additional prognostic stratification as compared to TTE, which may have direct impact on the indication of implantable cardioverter–defibrillator implantation.
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Affiliation(s)
- Gianluca Pontone
- From the Centro Cardiologico Monzino, IRCCS, Milan, Italy (G.P., D.A., M.G., S.M., A.B., V.B., L.F., C.S., E.C., P.G., A.D.R., M.M., F.T., C.T., P.A., A.L.B., M.P.); Department of Emergency and Organ Transplantation, Institute of Cardiovascular Disease, University Hospital Policlinico Consorziale of Bari, Italy (A.I.G.); Department of Medical and Surgical Sciences, University of Foggia, Italy (A.I.G.); Department of Cardiovascular Sciences and Community Health, University of Milan, Italy (D.A., A.S
| | - Andrea I. Guaricci
- From the Centro Cardiologico Monzino, IRCCS, Milan, Italy (G.P., D.A., M.G., S.M., A.B., V.B., L.F., C.S., E.C., P.G., A.D.R., M.M., F.T., C.T., P.A., A.L.B., M.P.); Department of Emergency and Organ Transplantation, Institute of Cardiovascular Disease, University Hospital Policlinico Consorziale of Bari, Italy (A.I.G.); Department of Medical and Surgical Sciences, University of Foggia, Italy (A.I.G.); Department of Cardiovascular Sciences and Community Health, University of Milan, Italy (D.A., A.S
| | - Daniele Andreini
- From the Centro Cardiologico Monzino, IRCCS, Milan, Italy (G.P., D.A., M.G., S.M., A.B., V.B., L.F., C.S., E.C., P.G., A.D.R., M.M., F.T., C.T., P.A., A.L.B., M.P.); Department of Emergency and Organ Transplantation, Institute of Cardiovascular Disease, University Hospital Policlinico Consorziale of Bari, Italy (A.I.G.); Department of Medical and Surgical Sciences, University of Foggia, Italy (A.I.G.); Department of Cardiovascular Sciences and Community Health, University of Milan, Italy (D.A., A.S
| | - Anna Solbiati
- From the Centro Cardiologico Monzino, IRCCS, Milan, Italy (G.P., D.A., M.G., S.M., A.B., V.B., L.F., C.S., E.C., P.G., A.D.R., M.M., F.T., C.T., P.A., A.L.B., M.P.); Department of Emergency and Organ Transplantation, Institute of Cardiovascular Disease, University Hospital Policlinico Consorziale of Bari, Italy (A.I.G.); Department of Medical and Surgical Sciences, University of Foggia, Italy (A.I.G.); Department of Cardiovascular Sciences and Community Health, University of Milan, Italy (D.A., A.S
| | - Marco Guglielmo
- From the Centro Cardiologico Monzino, IRCCS, Milan, Italy (G.P., D.A., M.G., S.M., A.B., V.B., L.F., C.S., E.C., P.G., A.D.R., M.M., F.T., C.T., P.A., A.L.B., M.P.); Department of Emergency and Organ Transplantation, Institute of Cardiovascular Disease, University Hospital Policlinico Consorziale of Bari, Italy (A.I.G.); Department of Medical and Surgical Sciences, University of Foggia, Italy (A.I.G.); Department of Cardiovascular Sciences and Community Health, University of Milan, Italy (D.A., A.S
| | - Saima Mushtaq
- From the Centro Cardiologico Monzino, IRCCS, Milan, Italy (G.P., D.A., M.G., S.M., A.B., V.B., L.F., C.S., E.C., P.G., A.D.R., M.M., F.T., C.T., P.A., A.L.B., M.P.); Department of Emergency and Organ Transplantation, Institute of Cardiovascular Disease, University Hospital Policlinico Consorziale of Bari, Italy (A.I.G.); Department of Medical and Surgical Sciences, University of Foggia, Italy (A.I.G.); Department of Cardiovascular Sciences and Community Health, University of Milan, Italy (D.A., A.S
| | - Andrea Baggiano
- From the Centro Cardiologico Monzino, IRCCS, Milan, Italy (G.P., D.A., M.G., S.M., A.B., V.B., L.F., C.S., E.C., P.G., A.D.R., M.M., F.T., C.T., P.A., A.L.B., M.P.); Department of Emergency and Organ Transplantation, Institute of Cardiovascular Disease, University Hospital Policlinico Consorziale of Bari, Italy (A.I.G.); Department of Medical and Surgical Sciences, University of Foggia, Italy (A.I.G.); Department of Cardiovascular Sciences and Community Health, University of Milan, Italy (D.A., A.S
| | - Virginia Beltrama
- From the Centro Cardiologico Monzino, IRCCS, Milan, Italy (G.P., D.A., M.G., S.M., A.B., V.B., L.F., C.S., E.C., P.G., A.D.R., M.M., F.T., C.T., P.A., A.L.B., M.P.); Department of Emergency and Organ Transplantation, Institute of Cardiovascular Disease, University Hospital Policlinico Consorziale of Bari, Italy (A.I.G.); Department of Medical and Surgical Sciences, University of Foggia, Italy (A.I.G.); Department of Cardiovascular Sciences and Community Health, University of Milan, Italy (D.A., A.S
| | - Laura Fusini
- From the Centro Cardiologico Monzino, IRCCS, Milan, Italy (G.P., D.A., M.G., S.M., A.B., V.B., L.F., C.S., E.C., P.G., A.D.R., M.M., F.T., C.T., P.A., A.L.B., M.P.); Department of Emergency and Organ Transplantation, Institute of Cardiovascular Disease, University Hospital Policlinico Consorziale of Bari, Italy (A.I.G.); Department of Medical and Surgical Sciences, University of Foggia, Italy (A.I.G.); Department of Cardiovascular Sciences and Community Health, University of Milan, Italy (D.A., A.S
| | - Cristina Rota
- From the Centro Cardiologico Monzino, IRCCS, Milan, Italy (G.P., D.A., M.G., S.M., A.B., V.B., L.F., C.S., E.C., P.G., A.D.R., M.M., F.T., C.T., P.A., A.L.B., M.P.); Department of Emergency and Organ Transplantation, Institute of Cardiovascular Disease, University Hospital Policlinico Consorziale of Bari, Italy (A.I.G.); Department of Medical and Surgical Sciences, University of Foggia, Italy (A.I.G.); Department of Cardiovascular Sciences and Community Health, University of Milan, Italy (D.A., A.S
| | - Chiara Segurini
- From the Centro Cardiologico Monzino, IRCCS, Milan, Italy (G.P., D.A., M.G., S.M., A.B., V.B., L.F., C.S., E.C., P.G., A.D.R., M.M., F.T., C.T., P.A., A.L.B., M.P.); Department of Emergency and Organ Transplantation, Institute of Cardiovascular Disease, University Hospital Policlinico Consorziale of Bari, Italy (A.I.G.); Department of Medical and Surgical Sciences, University of Foggia, Italy (A.I.G.); Department of Cardiovascular Sciences and Community Health, University of Milan, Italy (D.A., A.S
| | - Edoardo Conte
- From the Centro Cardiologico Monzino, IRCCS, Milan, Italy (G.P., D.A., M.G., S.M., A.B., V.B., L.F., C.S., E.C., P.G., A.D.R., M.M., F.T., C.T., P.A., A.L.B., M.P.); Department of Emergency and Organ Transplantation, Institute of Cardiovascular Disease, University Hospital Policlinico Consorziale of Bari, Italy (A.I.G.); Department of Medical and Surgical Sciences, University of Foggia, Italy (A.I.G.); Department of Cardiovascular Sciences and Community Health, University of Milan, Italy (D.A., A.S
| | - Paola Gripari
- From the Centro Cardiologico Monzino, IRCCS, Milan, Italy (G.P., D.A., M.G., S.M., A.B., V.B., L.F., C.S., E.C., P.G., A.D.R., M.M., F.T., C.T., P.A., A.L.B., M.P.); Department of Emergency and Organ Transplantation, Institute of Cardiovascular Disease, University Hospital Policlinico Consorziale of Bari, Italy (A.I.G.); Department of Medical and Surgical Sciences, University of Foggia, Italy (A.I.G.); Department of Cardiovascular Sciences and Community Health, University of Milan, Italy (D.A., A.S
| | - Antonio Dello Russo
- From the Centro Cardiologico Monzino, IRCCS, Milan, Italy (G.P., D.A., M.G., S.M., A.B., V.B., L.F., C.S., E.C., P.G., A.D.R., M.M., F.T., C.T., P.A., A.L.B., M.P.); Department of Emergency and Organ Transplantation, Institute of Cardiovascular Disease, University Hospital Policlinico Consorziale of Bari, Italy (A.I.G.); Department of Medical and Surgical Sciences, University of Foggia, Italy (A.I.G.); Department of Cardiovascular Sciences and Community Health, University of Milan, Italy (D.A., A.S
| | - Massimo Moltrasio
- From the Centro Cardiologico Monzino, IRCCS, Milan, Italy (G.P., D.A., M.G., S.M., A.B., V.B., L.F., C.S., E.C., P.G., A.D.R., M.M., F.T., C.T., P.A., A.L.B., M.P.); Department of Emergency and Organ Transplantation, Institute of Cardiovascular Disease, University Hospital Policlinico Consorziale of Bari, Italy (A.I.G.); Department of Medical and Surgical Sciences, University of Foggia, Italy (A.I.G.); Department of Cardiovascular Sciences and Community Health, University of Milan, Italy (D.A., A.S
| | - Fabrizio Tundo
- From the Centro Cardiologico Monzino, IRCCS, Milan, Italy (G.P., D.A., M.G., S.M., A.B., V.B., L.F., C.S., E.C., P.G., A.D.R., M.M., F.T., C.T., P.A., A.L.B., M.P.); Department of Emergency and Organ Transplantation, Institute of Cardiovascular Disease, University Hospital Policlinico Consorziale of Bari, Italy (A.I.G.); Department of Medical and Surgical Sciences, University of Foggia, Italy (A.I.G.); Department of Cardiovascular Sciences and Community Health, University of Milan, Italy (D.A., A.S
| | - Federico Lombardi
- From the Centro Cardiologico Monzino, IRCCS, Milan, Italy (G.P., D.A., M.G., S.M., A.B., V.B., L.F., C.S., E.C., P.G., A.D.R., M.M., F.T., C.T., P.A., A.L.B., M.P.); Department of Emergency and Organ Transplantation, Institute of Cardiovascular Disease, University Hospital Policlinico Consorziale of Bari, Italy (A.I.G.); Department of Medical and Surgical Sciences, University of Foggia, Italy (A.I.G.); Department of Cardiovascular Sciences and Community Health, University of Milan, Italy (D.A., A.S
| | - Giuseppe Muscogiuri
- From the Centro Cardiologico Monzino, IRCCS, Milan, Italy (G.P., D.A., M.G., S.M., A.B., V.B., L.F., C.S., E.C., P.G., A.D.R., M.M., F.T., C.T., P.A., A.L.B., M.P.); Department of Emergency and Organ Transplantation, Institute of Cardiovascular Disease, University Hospital Policlinico Consorziale of Bari, Italy (A.I.G.); Department of Medical and Surgical Sciences, University of Foggia, Italy (A.I.G.); Department of Cardiovascular Sciences and Community Health, University of Milan, Italy (D.A., A.S
| | - Valentina Lorenzoni
- From the Centro Cardiologico Monzino, IRCCS, Milan, Italy (G.P., D.A., M.G., S.M., A.B., V.B., L.F., C.S., E.C., P.G., A.D.R., M.M., F.T., C.T., P.A., A.L.B., M.P.); Department of Emergency and Organ Transplantation, Institute of Cardiovascular Disease, University Hospital Policlinico Consorziale of Bari, Italy (A.I.G.); Department of Medical and Surgical Sciences, University of Foggia, Italy (A.I.G.); Department of Cardiovascular Sciences and Community Health, University of Milan, Italy (D.A., A.S
| | - Claudio Tondo
- From the Centro Cardiologico Monzino, IRCCS, Milan, Italy (G.P., D.A., M.G., S.M., A.B., V.B., L.F., C.S., E.C., P.G., A.D.R., M.M., F.T., C.T., P.A., A.L.B., M.P.); Department of Emergency and Organ Transplantation, Institute of Cardiovascular Disease, University Hospital Policlinico Consorziale of Bari, Italy (A.I.G.); Department of Medical and Surgical Sciences, University of Foggia, Italy (A.I.G.); Department of Cardiovascular Sciences and Community Health, University of Milan, Italy (D.A., A.S
| | - Piergiuseppe Agostoni
- From the Centro Cardiologico Monzino, IRCCS, Milan, Italy (G.P., D.A., M.G., S.M., A.B., V.B., L.F., C.S., E.C., P.G., A.D.R., M.M., F.T., C.T., P.A., A.L.B., M.P.); Department of Emergency and Organ Transplantation, Institute of Cardiovascular Disease, University Hospital Policlinico Consorziale of Bari, Italy (A.I.G.); Department of Medical and Surgical Sciences, University of Foggia, Italy (A.I.G.); Department of Cardiovascular Sciences and Community Health, University of Milan, Italy (D.A., A.S
| | - Antonio L. Bartorelli
- From the Centro Cardiologico Monzino, IRCCS, Milan, Italy (G.P., D.A., M.G., S.M., A.B., V.B., L.F., C.S., E.C., P.G., A.D.R., M.M., F.T., C.T., P.A., A.L.B., M.P.); Department of Emergency and Organ Transplantation, Institute of Cardiovascular Disease, University Hospital Policlinico Consorziale of Bari, Italy (A.I.G.); Department of Medical and Surgical Sciences, University of Foggia, Italy (A.I.G.); Department of Cardiovascular Sciences and Community Health, University of Milan, Italy (D.A., A.S
| | - Mauro Pepi
- From the Centro Cardiologico Monzino, IRCCS, Milan, Italy (G.P., D.A., M.G., S.M., A.B., V.B., L.F., C.S., E.C., P.G., A.D.R., M.M., F.T., C.T., P.A., A.L.B., M.P.); Department of Emergency and Organ Transplantation, Institute of Cardiovascular Disease, University Hospital Policlinico Consorziale of Bari, Italy (A.I.G.); Department of Medical and Surgical Sciences, University of Foggia, Italy (A.I.G.); Department of Cardiovascular Sciences and Community Health, University of Milan, Italy (D.A., A.S
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