Author + information
- Saleem Toro,
- Serge Harb,
- Nancy Obuchowski,
- Niraj Varma,
- Scott Flamm,
- Brian Griffin and
- Deborah Kwon
Background: Cardiac re-synchronization therapy (CRT) is a proven therapy in patients (pts) with cardiomyopathy (CM). In these pts, the presence of myocardial scar (Sc), by cardiac magnetic resonance (CMR), is a poor prognostic factor. We sought to assess the effect of Sc on survival in pts undergoing CRT.
Methods: We included 98 consecutive pts with CM (54% ischemic) who underwent CMR followed by CRT placement. Overall survival was the primary outcome with a median follow-up of 2.5 years (yrs) post CRT implantation. A Cox proportional hazards regression model was built to predict mortality as a function of % Sc on CMR, after adjustment for baseline risk factors, including LBBB and an interaction term between % Sc and time.
Results: Mean age was 62 yrs (+/- 12), 33% were females. Mean EF by CMR was 23% (+/- 10) with a median time from CMR to CRT of 81 days. During follow-up, 28 patients died (22 with ICM). After adjusting for baseline factors and LBBB, % Sc × time was statistically significant. %Sc significantly predicted mortality in the 1st year post CRT; the estimated HR for pts with moderate (5-30%) and severe scar (>30%) were 36.2 and 61.7, relative to those with mild scar (p=0.001 and p=0.007); in contrast, the estimated HRs were 0.54 and 1.31, respectively for moderate and severe scar (p<0.001 and p=0.012) after 1 year, (Figure 1).
Conclusions: In pts with CM undergoing CRT, higher %Sc is associated with significant risk of mortality in the 1st year, with a diminished effect as time passes.
Poster Hall, Hall C
Friday, March 17, 2017, 10:00 a.m.-10:45 a.m.
Session Title: Non Invasive Imaging: MR Characterization and Function
Abstract Category: 29. Non Invasive Imaging: MR
Presentation Number: 1118-215
- 2017 American College of Cardiology Foundation