Utility of Computed Tomography to Predict Ventricular Arrhythmias in Patients With Nonischemic Cardiomyopathy Receiving Cardiac Resynchronization Therapy - 25/01/20
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Résumé |
The residual risk of ventricular arrhythmia (VA) after cardiac resynchronization therapy (CRT) implantation in patients with nonischemic cardiomyopathy (NICM) remains difficult to evaluate. The impact of left ventricular (LV) wall thickness (WT) measured using computed tomography (CT) on the occurrence of VA after CRT implantation has never been investigated. In this pilot study, we examined the association of LV WT and the occurrence of VA in NICM patients receiving CRT. Thirty three patients with NICM scheduled for CRT underwent preprocedural CT. Reduced LV WT was defined as WT <6 mm and quantified as a percentage of total LV area. The end point was the occurrence of VA episode during 2-years follow-up after CRT implantation. During the 2-years follow-up, a total of 37 VA episodes occurred in 6 (18.2%) patients. Patients with VA exhibited significantly higher NT-pro BNP level before CRT implantation. Additionally, CT analysis showed that patients with VA had a higher percentage of total LV with reduced WT compared with those free from VA (49.5% vs 25.8%, respectively; p = 0.005). In multivariable analysis, the total percentage of LV area with WT <6 mm was the only predictor of VA (odds ratio 1.07 [1.00 to 1.14]; p = 0.047). Receiver-operator curves analysis for total percentage of LVWT <6 mm demonstrated that an optimal cut-off value of 40% differentiated patients at risk of VA. In conclusion, LVWT evaluated using cardiac CT is an independent predictor of VA in NICM patients implanted with CRT. Patients with a total percentage of LVWT <6 mm ≥40% are especially at high risk of VA after CRT implantation.
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Funding sources: The study was supported by NIH/NHLBI K23HL098370 and Abbott (formerly St. Jude Medical). Dr. Truong also received support from the NIH L30HL093896. Funders had no role in this study. This research was supported by the French Federation of Cardiology and the Rennes University Hospital. |
Vol 125 - N° 4
P. 607-612 - février 2020 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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