Author's Accepted Manuscript
Noninvasive Imaging Markers Associated with Sudden Cardiac Death Pieter van der Bijl MB,ChB, MMed, Victoria Delgado MD, PhD, Jeroen J. Bax MD, PhD
www.elsevier.com/locate/tcm
PII: DOI: Reference:
S1050-1738(15)00241-8 http://dx.doi.org/10.1016/j.tcm.2015.10.003 TCM6224
To appear in: trends in cardiovascular medicine
Cite this article as: Pieter van der Bijl MB,ChB, MMed, Victoria Delgado MD, PhD, Jeroen J. Bax MD, PhD, Noninvasive Imaging Markers Associated with Sudden Cardiac Death, trends in cardiovascular medicine, http://dx.doi.org/10.1016/j.tcm.2015.10.003 This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting galley proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
Noninvasive imaging markers associated with sudden cardiac death Authors: Pieter van der Bijl MB,ChB, MMed, Victoria Delgado MD, PhD, Jeroen J. Bax MD, PhD From: Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Leiden, The Netherlands Short title: Non-invasive imaging and SCD Word count: 6669
Dr. Bax reports grants from Edwards Lifesciences, grants from Biotronik, grants from Boston Scientific, grants from Medtronic, outside the submitted work; Dr. Delgado reports grants from Edwards Lifesciences, grants from Biotronik, grants from Boston Scientific, grants from Medtronic, personal fees from Abbott Vascular, outside the submitted work
Address for correspondence: Jeroen J Bax, MD, PhD; Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, The Netherlands. Telephone: +31 71 526 2020, FAX: +31 71 526 6809; e-mail: [email protected]
1
Abstract Sudden cardiac death (SCD) accounts for approximately 15-20% of all deaths worldwide. While the majority of SCDs occur in adults, children and adults < 35 years (1.45% of the LV volume, the risk of VT/VF increases significantly.17;18 However, beyond these 5
thresholds of scar mass the risk of arrhythmia reaches a plateau suggesting that there may be additional factors that may affect arrhythmic risk. The higher spatial resolution of CMR compared with nuclear imaging techniques permits accurate differentiation and quantification of the peri-infarct zone by applying different thresholds of signal intensity (contrast enhancement). While the core infarct zone is characterized by dense fibrotic tissue, the peri-infarct zone consists of bundles of viable myocardium interspersed with fibrous tissue (Figure 2). The cells of these areas have long refractory periods and lead to slow conduction and conduction block allowing re-entrant circuits and development of VT/VF. The prognostic value and the association between the extent of peri-infarct zone assessed with contrast-enhanced CMR and risk of appropriate ICD shocks/therapies (reflecting VT/VF) has been demonstrated in several studies.19-21 Of 301 ischemic heart disease patients (65% with LVEF>35%) who underwent contrast-enhanced CMR, 66 died (44 cardiac deaths with 13 SCD) during a median follow-up of 3.9 years.20 Deceased patients had significantly greater percentage of peri-infarct zone percentage compared with survivors (29.4 vs. 17.5% g, p35%, patients with a low percentage of peri-infarct zone (35% and larger percentage of peri-infarct zone (≥25%) showed comparable survival as noted in patients with LVEF
Noninvasive Imaging Markers Associated with Sudden Cardiac Death Pieter van der Bijl MB,ChB, MMed, Victoria Delgado MD, PhD, Jeroen J. Bax MD, PhD
www.elsevier.com/locate/tcm
PII: DOI: Reference:
S1050-1738(15)00241-8 http://dx.doi.org/10.1016/j.tcm.2015.10.003 TCM6224
To appear in: trends in cardiovascular medicine
Cite this article as: Pieter van der Bijl MB,ChB, MMed, Victoria Delgado MD, PhD, Jeroen J. Bax MD, PhD, Noninvasive Imaging Markers Associated with Sudden Cardiac Death, trends in cardiovascular medicine, http://dx.doi.org/10.1016/j.tcm.2015.10.003 This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting galley proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
Noninvasive imaging markers associated with sudden cardiac death Authors: Pieter van der Bijl MB,ChB, MMed, Victoria Delgado MD, PhD, Jeroen J. Bax MD, PhD From: Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Leiden, The Netherlands Short title: Non-invasive imaging and SCD Word count: 6669
Dr. Bax reports grants from Edwards Lifesciences, grants from Biotronik, grants from Boston Scientific, grants from Medtronic, outside the submitted work; Dr. Delgado reports grants from Edwards Lifesciences, grants from Biotronik, grants from Boston Scientific, grants from Medtronic, personal fees from Abbott Vascular, outside the submitted work
Address for correspondence: Jeroen J Bax, MD, PhD; Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, The Netherlands. Telephone: +31 71 526 2020, FAX: +31 71 526 6809; e-mail: [email protected]
1
Abstract Sudden cardiac death (SCD) accounts for approximately 15-20% of all deaths worldwide. While the majority of SCDs occur in adults, children and adults < 35 years (1.45% of the LV volume, the risk of VT/VF increases significantly.17;18 However, beyond these 5
thresholds of scar mass the risk of arrhythmia reaches a plateau suggesting that there may be additional factors that may affect arrhythmic risk. The higher spatial resolution of CMR compared with nuclear imaging techniques permits accurate differentiation and quantification of the peri-infarct zone by applying different thresholds of signal intensity (contrast enhancement). While the core infarct zone is characterized by dense fibrotic tissue, the peri-infarct zone consists of bundles of viable myocardium interspersed with fibrous tissue (Figure 2). The cells of these areas have long refractory periods and lead to slow conduction and conduction block allowing re-entrant circuits and development of VT/VF. The prognostic value and the association between the extent of peri-infarct zone assessed with contrast-enhanced CMR and risk of appropriate ICD shocks/therapies (reflecting VT/VF) has been demonstrated in several studies.19-21 Of 301 ischemic heart disease patients (65% with LVEF>35%) who underwent contrast-enhanced CMR, 66 died (44 cardiac deaths with 13 SCD) during a median follow-up of 3.9 years.20 Deceased patients had significantly greater percentage of peri-infarct zone percentage compared with survivors (29.4 vs. 17.5% g, p35%, patients with a low percentage of peri-infarct zone (35% and larger percentage of peri-infarct zone (≥25%) showed comparable survival as noted in patients with LVEF
