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01 Dec 2020
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Tristan Manalac, Yesterday
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Visually assessed myocardial fibrosis plus quantified GZF tied to sudden death, arrhythmic events

Stephen Padilla
07 Jan 2021

Myocardial fibrosis on visual assessment (MFVA) and quantified “gray zone” of myocardial fibrosis using the 3SD method (GZF3SD) more strongly predicts sudden cardiac death (SCD) and ventricular arrhythmia (VA) than reduced left ventricular ejection fraction (LVEF) in patients with coronary artery disease (CAD), according to a study.

“On this basis, we propose that arrhythmic risk stratification in CAD patients should focus on MFVA and then on quantifying GZF3SD mass, rather than on LVEF,” the researchers said. “Whether or not this decision pathway translates to benefit from implantable cardioverter-defibrillator (ICD) therapy requires a randomized controlled trial.”

This retrospective study of 979 CAD patients (mean age, 65.8±12.3 years) assessed the presence of MFVA and GZF mass in relation to SCD and the composite, arrhythmic endpoint of SCD or VAs.

Of the patients, 29 (2.96 percent) experienced SCD and 80 (8.17 percent) met the arrhythmic endpoint over a median 5.82 years (interquartile range, 4.1–7.3 years). MVFA in the whole cohort showed a robust association with SCD (hazard ratio [HR], 10.1, 95 percent confidence interval [CI], 1.42–1,278.9) and the arrhythmic endpoint (HR, 28.0, 95 percent CI, 4.07–3,525.4). [J Am Coll Cardiol 2021;77:29-41]

Competing risks analyses revealed weaker associations between LVED <35 percent and SCD (subdistribution [s]HR, 2.99, 95 percent CI, 1.42–6.31) and the arrhythmic endpoint (sHR, 4.71, 95 percent CI, 2.97–7.47).

In competing risk analyses of the MVFA subcohort (n=832), GZF3SD >5.0 g strongly correlated with SCD (sHR, 10.8, 95 percent CI, 3.74–30.9) and the arrhythmic endpoint (sHR, 7.40, 95 percent CI, 4.29–12.8). Associations were weaker between LVEF <35 percent and SCD (sHR, 2.62, 95 percent CI, 1.24–5.52) and the arrhythmic endpoint (sHR, 4.14, 95 percent CI, 2.61–6.57).

“We may ask whether GZF mass adds to the predictive value of CMR beyond MFVA. In this respect, early electrophysiological studies suggested that GZF provides a substrate for VAs,” the researchers said. [J Cardiovasc Electrophysiol 2005;16:465-471]

“Subsequently, several small studies, mainly comprising CAD patients undergoing ICD therapy, have supported a link between GZF and VAs,” they added. [Circ Cardiovasc Imaging 2009;2:183-190; Heart 2011;97:1951-1956; Int J Cardiol 2014;177:392-399; J Am Coll Cardiol Img 2018;11:561-572; Heart Rhythm 2015;12:802-808]

In addition, findings of the current study emerged in the context that primary prevention ICDs are prescribed based on LVEF <35 percent or <30 percent, consistent with the inclusion criteria of the primary prevention ICD trials. [N Engl J Med 2002;346:877-883; N Engl J Med 2005;352:225-237]

“Although these trials confirmed a role for LVEF in patient selection, they did not validate LVEF as a risk predictor in broad populations of CAD patients,” the researchers said. “Moreover, they do not inform on SCD risk in patients with an LVEF >35 percent.”

The current study was limited by its retrospective design. It was based on referrals to a tertiary cardiovascular magnetic resonance centre, so findings could not be generalized to primary care or the general population. In addition, CMR variables were not compared with the panoply of variables that have previously been proposed for arrhythmic risk stratification.

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Most Read Articles
01 Dec 2020
Tetanus toxoid 5 Lf, diphtheria toxoid 2 Lf, pertussis toxoid 2.5 mcg, filamentous haemagglutinin 5 mcg, fimbriae types 2 and 3 5 mcg, pertactin 3 mcg
Dr. Hsu Li Yang, Dr. Tan Thuan Tong, Dr. Andrea Kwa, 08 Jan 2021
Antimicrobial resistance has become increasingly dire as the rapid emergence of drug resistance, especially gram-negative pathogens, has outpaced the development of new antibiotics. At a recent virtual symposium, Dr Hsu Li Yang, Vice Dean (Global Health) and Programme Leader (Infectious Diseases), NUS Saw Swee Hock School of Public Health, presented epidemiological data on multidrug-resistant (MDR) gram-negative bacteria (GNB) in Asia, while Dr Tan Thuan Tong, Head and Senior Consultant, Department of Infectious Diseases, Singapore General Hospital (SGH), focused on the role of ceftazidime-avibactam in MDR GNB infections. Dr Andrea Kwa, Assistant Director of Research, Department of Pharmacy, SGH, joined the panel in an interactive fireside chat, to discuss challenges, practical considerations, and solutions in MDR gram-negative infections. This Pfizer-sponsored symposium was chaired by Dr Ng Shin Yi, Head and Senior Consultant of Surgical Intensive Care, SGH.
Tristan Manalac, Yesterday
While antibody titres against SARS-CoV-2 wane with time, the immune system is capable of producing memory B-cells that can last for at least 6 months after infection, suggesting that the body will be able to protect itself in the case of re-exposure, according to a new study.
Jairia Dela Cruz, 5 days ago
Spending too much time sitting cannot be good for the body, and rising to one's feet breaks up such a behaviour and yields small, but meaningful, reductions in certain cardiovascular disease (CVD) risk factors, according to the results of a meta-analysis.