Author + information
- Received June 25, 2019
- Revision received September 23, 2019
- Accepted October 10, 2019
- Published online April 6, 2020.
- Kenneth C. Bilchick, MD, MSa,∗ (, )
- Daniel A. Auger, PhDb,
- Mohammad Abdishektaei, MSb,
- Roshin Mathew, MDa,
- Min-Woong Sohn, PhDc,
- Xiaoying Cai, BSb,
- Changyu Sun, PhDb,
- Aditya Narayan, BSb,
- Rohit Malhotra, MDa,
- Andrew Darby, MDa,
- J. Michael Mangrum, MDa,
- Nishaki Mehta, MDa,
- John Ferguson, MDa,
- Sula Mazimba, MDa,
- Pamela K. Mason, MDa,
- Christopher M. Kramer, MDa,d,
- Wayne C. Levy, MDe and
- Frederick H. Epstein, PhDb,d
- aDepartment of Medicine, University of Virginia Health System, Charlottesville, Virginia
- bDepartment of Biomedical Engineering, University of Virginia Health System, Charlottesville, Virginia
- cDepartment of Public Health Sciences, University of Virginia Health System, Charlottesville, Virginia
- dDepartment of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, Virginia
- eDepartment of Medicine, University of Washington, Seattle, Washington
- ↵∗Address for correspondence:
Dr. Kenneth C. Bilchick, University of Virginia Health System, Cardiovascular Division, P.O. Box 800158, Charlottesville, Virginia 22908.
Objectives This study sought to determine if combining the Seattle Heart Failure Model (SHFM-D) and cardiac magnetic resonance (CMR) provides complementary prognostic data for patients with cardiac resynchronization therapy (CRT) defibrillators.
Background The SHFM-D is among the most widely used risk stratification models for overall survival in patients with heart failure and implantable cardioverter-defibrillators (ICDs), and CMR provides highly detailed information regarding cardiac structure and function.
Methods CMR Displacement Encoding with Stimulated Echoes (DENSE) strain imaging was used to generate the circumferential uniformity ratio estimate with singular value decomposition (CURE-SVD) circumferential strain dyssynchrony parameter, and the SHFM-D was determined from clinical parameters. Multivariable Cox proportional hazards regression was used to determine adjusted hazard ratios and time-dependent areas under the curve for the primary endpoint of death, heart transplantation, left ventricular assist device, or appropriate ICD therapies.
Results The cohort consisted of 100 patients (65.5 [interquartile range 57.7 to 72.7] years; 29% female), of whom 47% had the primary clinical endpoint and 18% had appropriate ICD therapies during a median follow-up of 5.3 years. CURE-SVD and the SHFM-D were independently associated with the primary endpoint (SHFM-D: hazard ratio: 1.47/SD; 95% confidence interval: 1.06 to 2.03; p = 0.02) (CURE-SVD: hazard ratio: 1.54/SD; 95% confidence interval: 1.12 to 2.11; p = 0.009). Furthermore, a favorable prognostic group (Group A, with CURE-SVD <0.60 and SHFM-D <0.70) comprising approximately one-third of the patients had a very low rate of appropriate ICD therapies (1.5% per year) and a greater (90%) 4-year survival compared with Group B (CURE-SVD ≥0.60 or SHFM-D ≥0.70) patients (p = 0.02). CURE-SVD with DENSE had a stronger correlation with CRT response (r = −0.57; p < 0.0001) than CURE-SVD with feature tracking (r = −0.28; p = 0.004).
Conclusions A combined approach to risk stratification using CMR DENSE strain imaging and a widely used clinical risk model, the SHFM-D, proved to be effective in this cohort of patients referred for CRT defibrillators. The combined use of CMR and clinical risk models represents a promising and novel paradigm to inform prognosis and device selection in the future.
- cardiac magnetic resonance
- cardiac resynchronization therapy
- heart failure
- implantable cardioverter-defibrillator
- risk models
This work was supported by the National Institutes of Health (R56 HL135556, Dr. Bilchick is Principal Investigator). Dr. Bilchick has received research grant support from Medtronic and Siemens Healthineers. Dr. Malhotra has received research grant support from Biosense Webster and Medtronic. Dr. Darby has received grant support from Medtronic and Biosense Webster. Dr. Mangrum has received research grant support from Boston Scientific, CardioFocus, and St. Jude Medical. Dr. Ferguson has received support from Biosense Webster. Dr. Mason is on the steering committee for Medtronic; and has received grant support from Medtronic, Boston Scientific, and Cook Medical. Drs. Kramer and Epstein have received research grant support from Siemens Healthineers. Dr. Levy is a consultant to Medtronic and Impulse Dynamics; a steering Committee member for ADMIRE ICD (GE Healthcare) and Respircardia Inc.; and is a clinical endpoint committee member for the CHAMPION Post Approval Study (CardioMEMS, Abbott, Baim Institute), SOLVE CRT (EBR Systems, Inc.). The University of Washington CoMotion holds the copyright to the Seattle Heart Failure Model. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Victor Ferrari, MD, served as Guest Editor for this paper.
- Received June 25, 2019.
- Revision received September 23, 2019.
- Accepted October 10, 2019.
- 2020 American College of Cardiology Foundation
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