Abstract | OBJECTIVES: This study sought to investigate the association of myocardial scar and ischemia with major arrhythmic events (MAEs) in patients with left ventricular ejection fraction (LVEF) ≤35%. BACKGROUND: METHODS: A total of 439 consecutive patients (median age, 70 years; 78% male; 55% with implantable cardioverter defibrillator [ICD]) referred for stress/rest positron emission tomography (PET) and resting LVEF ≤35% were included. Primary outcome was time-to-first MAE defined as sudden cardiac death, resuscitated sudden cardiac death, or appropriate ICD shocks for ventricular tachyarrhythmias ascertained by blinded adjudication of hospital records, Social Security Administration's Death Masterfile, National Death Index, and ICD vendor databases. RESULTS: Ninety-one MAEs including 20 sudden cardiac deaths occurred in 75 (17%) patients during a median follow-up of 3.2 years. Transmural myocardial scar was strongly associated with MAEs beyond age, sex, cardiovascular risk factors, beta-blocker therapy, and resting LVEF (adjusted hazard ratio per 10% increase in scar, 1.48 [95% confidence interval: 1.22 to 1.80]; p < 0.001). However, non transmural scar/hibernation or markers of myocardial ischemia on PET including global or peri- infarct ischemia, coronary flow reserve, and resting or hyperemic myocardial blood flows were not associated with MAEs in univariable or multivariable analysis. These findings remained robust in subgroup analyses of patients with ICD (n = 223), with ischemic cardiomyopathy (n = 287), and in patients without revascularization after the PET scan (n = 365). CONCLUSIONS:
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Authors | Ankur Gupta, Meagan Harrington, Christine M Albert, Navkaranbir S Bajaj, Jon Hainer, Victoria Morgan, Courtney F Bibbo, Paco E Bravo, Michael T Osborne, Sharmila Dorbala, Ron Blankstein, Viviany R Taqueti, Deepak L Bhatt, William G Stevenson, Marcelo F Di Carli |
Journal | JACC. Clinical electrophysiology
(JACC Clin Electrophysiol)
Vol. 4
Issue 9
Pg. 1200-1210
(09 2018)
ISSN: 2405-5018 [Electronic] United States |
PMID | 30236394
(Publication Type: Journal Article, Research Support, N.I.H., Extramural)
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Copyright | Copyright © 2018 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved. |
Topics |
- Aged
- Arrhythmias, Cardiac
(complications, epidemiology)
- Cardiomyopathies
(complications, epidemiology)
- Death, Sudden, Cardiac
(epidemiology)
- Defibrillators, Implantable
(adverse effects)
- Female
- Heart Failure
(complications, epidemiology)
- Humans
- Male
- Middle Aged
- Myocardial Ischemia
(complications, epidemiology)
- Positron-Emission Tomography
- Retrospective Studies
- Stroke Volume
(physiology)
- Ventricular Dysfunction, Left
(epidemiology)
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