Left Atrial Function Using Cardiovascular Magnetic Resonance Imaging Independently Predicts Life-Threatening Arrhythmias in Patients Referred to Receive a Primary Prevention Implantable Cardioverter Defibrillator

Carmen P Lydell; Yoko Mikami; Kai Homer; Mingkai Peng; Aidan Cornhill; Archa Rajagopalan; Punitha Arasaratnam; Karen Cowan; Andrew Roberts; Claire Sumner; Bobak Heydari; Andrew G Howarth; Derek Exner; James A White

doi:10.1016/j.cjca.2019.04.015

Left Atrial Function Using Cardiovascular Magnetic Resonance Imaging Independently Predicts Life-Threatening Arrhythmias in Patients Referred to Receive a Primary Prevention Implantable Cardioverter Defibrillator

Can J Cardiol. 2019 Sep;35(9):1149-1157. doi: 10.1016/j.cjca.2019.04.015. Epub 2019 Apr 23.

Affiliations

¹ Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada.
² Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
³ Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada; Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
⁴ Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada; Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada. Electronic address: jawhit@ucalgary.ca.

PMID: 31472813
DOI: 10.1016/j.cjca.2019.04.015

Abstract

Background: In this study we aimed to investigate left atrial (LA) function, measured from routine cine cardiovascular magnetic resonance imaging, to determine its value for the prediction of sudden cardiac death (SCD) or appropriate implantable cardioverter defibrillator (ICD) shock in patients who received primary prevention ICD implantation.

Methods: We studied 203 patients with ischemic or idiopathic nonischemic dilated cardiomyopathy who underwent cardiovascular magnetic resonance imaging before primary prevention ICD implantation. LA volumes were measured at end-diastole and end-systole from 4- and 2-chamber cine images, and LA emptying function (LAEF) calculated. Patients were followed for the primary composite end point of SCD or appropriate ICD shock.

Results: Mean age was 61 ± 12 years with a mean left ventricular ejection fraction of 24 ± 7%. The mean LAEF was 27 ± 15% (range, 0.9%-73%). At a median follow-up of 1639 days, 35 patients (17%) experienced the primary composite outcome. LAEF was strongly associated with the primary outcome (P = 0.001); patients with an LAEF ≤ 30% experienced a cumulative event rate of 26.1% vs 5.7% (hazard ratio, 5.5; P < 0.001) in patients above this cutoff. This finding was maintained in multivariable analysis (hazard ratio, 4.7; P = 0.002) and was consistently shown in the ischemic and nonischemic dilated cardiomyopathy subgroups.

Conclusions: LAEF is a simple, powerful, and independent predictor of SCD in patients being referred for primary prevention ICD implantation.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Alberta / epidemiology
Arrhythmias, Cardiac / complications
Arrhythmias, Cardiac / diagnosis*
Arrhythmias, Cardiac / physiopathology
Atrial Function, Left / physiology*
Death, Sudden, Cardiac / epidemiology
Death, Sudden, Cardiac / etiology
Death, Sudden, Cardiac / prevention & control*
Defibrillators, Implantable
Female
Follow-Up Studies
Heart Atria / diagnostic imaging*
Heart Atria / physiopathology
Humans
Incidence
Magnetic Resonance Imaging, Cine / methods
Male
Middle Aged
Primary Prevention / methods*
Reproducibility of Results
Retrospective Studies
Risk Assessment / methods*
Risk Factors