Abstract
Background: For the primary prevention of sudden cardiac death, guidelines provide left ventricular ejection fraction (EF) criteria for implantable cardioverter defibrillator (ICD) placement. We sought to investigate the potential impact of performing cardiovascular magnetic resonance (CMR) for EF on ICD eligibility.
Methods: Patients referred for consideration of ICD implantation underwent CMR for EF measurement within 30 days of echocardiography. Echocardiographic EF was determined by Simpson's biplane method and CMR EF was measured by Simpson's summation of discs method.
Results: Fifty-two patients (age 62±15 years, 81% male) had a mean EF of 38±14% by echocardiography and 35±14% by CMR. CMR had greater reproducibility than echocardiography for both intra-observer (ICC, 0.98 vs 0.94) and inter-observer comparisons (ICC 0.99 vs 0.93). The limits of agreement comparing CMR and echocardiographic EF were −16 to +10 percentage points. CMR resulted in 11 of 52 (21%) and 5 of 52 (10%) of patients being reclassified regarding ICD eligibility at the EF thresholds of 35 and 30%, respectively. Among patients with an echocardiographic EF of between 25 and 40%, nine of 22 (41%) were reclassified by CMR at either the 35 or 30% threshold. Echocardiography identified only one of the six patients with left ventricular thrombus noted incidentally on CMR.
Conclusions: CMR resulted in 21% of patients being reclassified regarding ICD eligibility when strict EF criteria were used. In addition, CMR detected unexpected left ventricular thrombus in almost 10% of patients.
Methods: Patients referred for consideration of ICD implantation underwent CMR for EF measurement within 30 days of echocardiography. Echocardiographic EF was determined by Simpson's biplane method and CMR EF was measured by Simpson's summation of discs method.
Results: Fifty-two patients (age 62±15 years, 81% male) had a mean EF of 38±14% by echocardiography and 35±14% by CMR. CMR had greater reproducibility than echocardiography for both intra-observer (ICC, 0.98 vs 0.94) and inter-observer comparisons (ICC 0.99 vs 0.93). The limits of agreement comparing CMR and echocardiographic EF were −16 to +10 percentage points. CMR resulted in 11 of 52 (21%) and 5 of 52 (10%) of patients being reclassified regarding ICD eligibility at the EF thresholds of 35 and 30%, respectively. Among patients with an echocardiographic EF of between 25 and 40%, nine of 22 (41%) were reclassified by CMR at either the 35 or 30% threshold. Echocardiography identified only one of the six patients with left ventricular thrombus noted incidentally on CMR.
Conclusions: CMR resulted in 21% of patients being reclassified regarding ICD eligibility when strict EF criteria were used. In addition, CMR detected unexpected left ventricular thrombus in almost 10% of patients.
| Original language | English |
|---|---|
| Article number | 503 |
| Pages (from-to) | S208 |
| Number of pages | 1 |
| Journal | Heart, Lung and Circulation |
| Volume | 21 |
| Issue number | Supplement 1 |
| DOIs | |
| Publication status | Published - 27 Jul 2012 |