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. 2023 Jan 23;24(2):181-189.
doi: 10.1093/ehjci/jeac227.

Impact of wideband cardiac magnetic resonance on diagnosis, decision-making and outcomes in patients with implantable cardioverter defibrillators

Hena N Patel  1 , Shuo Wang  1 , Swati Rao  1 , Amita Singh  1 , Luis Landeras  2 , Stephanie A Besser  1 , Spencer Carter  1 , Satish Mishra  1 , Takuro Nishimura  1 , Dalise Y Shatz  1 , Roderick Tung  1 , Hemal Nayak  1 , Keigo Kawaji  3 , Victor Mor-Avi  1 , Amit R Patel  1   2
Affiliations

Impact of wideband cardiac magnetic resonance on diagnosis, decision-making and outcomes in patients with implantable cardioverter defibrillators

Hena N Patel et al. Eur Heart J Cardiovasc Imaging. .

Abstract

Aims: Although myocardial scar assessment using late gadolinium enhancement (LGE) cardiac magnetic resonance (CMR) imaging is frequently indicated for patients with implantable cardioverter defibrillators (ICDs), metal artefact can degrade image quality. With the new wideband technique designed to mitigate device related artefact, CMR is increasingly used in this population. However, the common clinical indications for CMR referral and impact on clinical decision-making and prognosis are not well defined. Our study was designed to address these knowledge gaps.

Methods and results: One hundred seventy-nine consecutive patients with an ICD (age 59 ± 13 years, 75% male) underwent CMR using cine and wideband pulse sequences for LGE imaging. Electronic medical records were reviewed to determine the reason for CMR referral, whether there was a change in clinical decision-making, and occurrence of major adverse cardiac events (MACEs). Referral indication was the most common evaluation of ventricular tachycardia (VT) substrate (n = 114, 64%), followed by cardiomyopathy (n = 53, 30%). Overall, CMR resulted in a new or changed diagnosis in 64 (36%) patients and impacted clinical management in 51 (28%). The effect on management change was highest in patients presenting with VT. A total of 77 patients (43%) experienced MACE during the follow-up period (median 1.7 years), including 65 in patients with evidence of LGE. Kaplan-Meier analysis showed that ICD patients with LGE had worse outcomes than those without LGE (P = 0.006).

Conclusion: The clinical yield from LGE CMR is high and provides management changing and meaningful prognostic information in a significant proportion of patients with ICDs.

Keywords: cardiac magnetic resonance; implantable cardioverter defibrillators; late gadolinium enhancement.

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Conflict of interest statement

Conflict of interest: K.K. and A.R.P. have received research support from Philips. The other authors do not have any relevant disclosures.

Figures

Graphical Abstract
Graphical Abstract
Left: Definition of significant clinical impact. Right: Change in diagnosis after CMR study.
Figure 1
Figure 1
Definition of significant clinical impact.
Figure 2
Figure 2
Change in diagnosis after CMR study. Weighted lines represent number of patients (also numerically represented within the circle).
Figure 3
Figure 3
Examples of a change in or new diagnosis. (A) A 58-year-old male with heart failure with reduced ejection of unclear aetiology was referred for cardiomyopathy evaluation, with findings suggestive of left ventricular non-compaction cardiomyopathy. (B) A 67-year-old male with non-ischaemic cardiomyopathy and recurrent VT referred for scar evaluation prior to ablation. LGE in the anteroseptal and inferoseptal segments with extension to the RV (‘hook sign’ in anteroseptum and ‘triangle sign’ in inferoseptum) was seen. Findings were highly probable for cardiac sarcoidosis, which was confirmed on biopsy.
Figure 4
Figure 4
Kaplan–Meier survival curves by presence of LGE (A), by total LGE area (B), and by LVEF (C).
See this image and copyright information in PMC

Comment in

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