Author + information
- Received April 17, 2017
- Revision received July 3, 2017
- Accepted July 5, 2017
- Published online August 28, 2017.
- Francisco Leyva, MDa,∗http://www.doctorleyva.com,
- Abbasin Zegard, MBChBa,
- Edmund Acquaye, MBChBb,
- Christopher Gubran, MBChBc,
- Robin Taylor, MBChBd,
- Paul W.X. Foley, MDd,
- Fraz Umar, MBChBd,
- Kiran Patel, PhDc,
- Jonathan Panting, MBChBc,
- Howard Marshall, MDb and
- Tian Qiu, PhDb
- aAston Medical Research Institute, Aston Medical School, Aston University, Birmingham, United Kingdom
- bQueen Elizabeth Hospital, Birmingham, United Kingdom
- cGood Hope Hospital, Sutton Coldfield, Birmingham, United Kingdom
- dCentre for Cardiovascular Sciences, University of Birmingham, United Kingdom
- ↵∗Address for correspondence:
Prof. Francisco Leyva, Aston Medical Research Institute, Aston University Medical School, Aston University, Aston Triangle, Birmingham B4 7ET, United Kingdom.
Background Recent studies have cast doubt on the benefit of cardiac resynchronization therapy (CRT) with defibrillation (CRT-D) versus pacing (CRT-P) for patients with nonischemic cardiomyopathy (NICM). Left ventricular myocardial scar portends poor clinical outcomes.
Objectives The aim of this study was to determine whether CRT-D is superior to CRT-P in patients with NICM either with (+) or without (−) left ventricular midwall fibrosis (MWF), detected by cardiac magnetic resonance.
Methods Clinical events were quantified in patients with NICM who were +MWF (n = 68) or −MWF (n = 184) who underwent cardiac magnetic resonance prior to CRT device implantation.
Results In the total study population, +MWF emerged as an independent predictor of total mortality (adjusted hazard ratio [aHR]: 2.31; 95% confidence interval [CI]: 1.45 to 3.68), total mortality or heart failure hospitalization (aHR: 2.02; 95% CI: 1.32 to 3.09), total mortality or hospitalization for major adverse cardiac events (aHR: 2.02; 95% CI: 1.32 to 3.07), death from pump failure (aHR: 1.95; 95% CI: 1.11 to 3.41), and sudden cardiac death (aHR: 3.75; 95% CI: 1.26 to 11.2) over a maximum follow-up period of 14 years (median 3.8 years [interquartile range: 2.0 to 6.1 years] for +MWF and 4.6 years [interquartile range: 2.4 to 8.3 years] for −MWF). In separate analyses of +MWF and −MWF, total mortality (aHR: 0.23; 95% CI: 0.07 to 0.75), total mortality or heart failure hospitalization (aHR: 0.32; 95% CI: 0.12 to 0.82), and total mortality or hospitalization for major adverse cardiac events (aHR: 0.30; 95% CI: 0.12 to 0.78) were lower after CRT-D than after CRT-P in +MWF but not in −MWF.
Conclusions In patients with NICM, CRT-D was superior to CRT-P in +MWF but not −MWF. These findings have implications for the choice of device therapy in patients with NICM.
- cardiac magnetic resonance imaging
- heart failure
- implantable cardioverter-defibrillator
- major adverse cardiac events
Prof. Leyva has held consultancies with and has received research funding from Medtronic, Boston Scientific, St. Jude Medical, and LivaNova. Dr. Patel has received speaking honoraria from Medtronic. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received April 17, 2017.
- Revision received July 3, 2017.
- Accepted July 5, 2017.
- 2017 The Authors