| Title |
Myocardial Scar But Not Ischemia Is Associated With Defibrillator Shocks and Sudden Cardiac Death in Stable Patients With Reduced Left Ventricular Ejection Fraction
|
|---|---|
| Published in |
JACC: Clinical Electrophysiology, July 2018
|
| DOI | 10.1016/j.jacep.2018.06.002 |
| Pubmed ID | |
| Authors |
Ankur Gupta, Meagan Harrington, Christine M. Albert, Navkaranbir S. Bajaj, Jon Hainer, Victoria Morgan, Courtney F. Bibbo, Paco E. Bravo, Michael T. Osborne, Sharmila Dorbala, Ron Blankstein, Viviany R. Taqueti, Deepak L. Bhatt, William G. Stevenson, Marcelo F. Di Carli |
| Abstract |
This study sought to investigate the association of myocardial scar and ischemia with major arrhythmic events (MAEs) in patients with left ventricular ejection fraction (LVEF) ≤35%. Although myocardial scar is a known substrate for ventricular arrhythmias, the association of myocardial ischemia with ventricular arrhythmias in stable patients with left ventricular dysfunction is less clear. A total of 439 consecutive patients (median age, 70 years; 78% male; 55% with implantable cardioverter defibrillator [ICD]) referred for stress/rest positron emission tomography (PET) and resting LVEF ≤35% were included. Primary outcome was time-to-first MAE defined as sudden cardiac death, resuscitated sudden cardiac death, or appropriate ICD shocks for ventricular tachyarrhythmias ascertained by blinded adjudication of hospital records, Social Security Administration's Death Masterfile, National Death Index, and ICD vendor databases. Ninety-one MAEs including 20 sudden cardiac deaths occurred in 75 (17%) patients during a median follow-up of 3.2 years. Transmural myocardial scar was strongly associated with MAEs beyond age, sex, cardiovascular risk factors, beta-blocker therapy, and resting LVEF (adjusted hazard ratio per 10% increase in scar, 1.48 [95% confidence interval: 1.22 to 1.80]; p < 0.001). However, non transmural scar/hibernation or markers of myocardial ischemia on PET including global or peri-infarct ischemia, coronary flow reserve, and resting or hyperemic myocardial blood flows were not associated with MAEs in univariable or multivariable analysis. These findings remained robust in subgroup analyses of patients with ICD (n = 223), with ischemic cardiomyopathy (n = 287), and in patients without revascularization after the PET scan (n = 365). Myocardial scar but not ischemia was associated with appropriate ICD shocks and sudden cardiac death in patients with LVEF ≤35%. These findings have implications for risk-stratification of patients with left ventricular dysfunction who may benefit from ICD therapy. |
X Demographics
The data shown below were collected from the profiles of 68 X users who shared this research output. Click here to find out more about how the information was compiled.
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| United States | 20 | 29% |
| Spain | 8 | 12% |
| United Kingdom | 5 | 7% |
| Australia | 3 | 4% |
| Venezuela, Bolivarian Republic of | 2 | 3% |
| Brazil | 2 | 3% |
| Colombia | 1 | 1% |
| Ireland | 1 | 1% |
| Afghanistan | 1 | 1% |
| Other | 10 | 15% |
| Unknown | 15 | 22% |
Demographic breakdown
| Type | Count | As % |
|---|---|---|
| Members of the public | 41 | 60% |
| Scientists | 12 | 18% |
| Practitioners (doctors, other healthcare professionals) | 11 | 16% |
| Science communicators (journalists, bloggers, editors) | 4 | 6% |
Mendeley readers
The data shown below were compiled from readership statistics for 26 Mendeley readers of this research output. Click here to see the associated Mendeley record.
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| Unknown | 26 | 100% |
Demographic breakdown
| Readers by professional status | Count | As % |
|---|---|---|
| Student > Master | 4 | 15% |
| Student > Doctoral Student | 4 | 15% |
| Other | 3 | 12% |
| Student > Postgraduate | 3 | 12% |
| Lecturer | 1 | 4% |
| Other | 5 | 19% |
| Unknown | 6 | 23% |
| Readers by discipline | Count | As % |
|---|---|---|
| Medicine and Dentistry | 11 | 42% |
| Engineering | 2 | 8% |
| Nursing and Health Professions | 1 | 4% |
| Sports and Recreations | 1 | 4% |
| Agricultural and Biological Sciences | 1 | 4% |
| Other | 2 | 8% |
| Unknown | 8 | 31% |
Attention Score in Context
This research output has an Altmetric Attention Score of 39. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 21 November 2019.
All research outputs
#1,040,957
of 25,385,509 outputs
Outputs from JACC: Clinical Electrophysiology
#178
of 1,554 outputs
Outputs of similar age
#22,034
of 341,271 outputs
Outputs of similar age from JACC: Clinical Electrophysiology
#5
of 51 outputs
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So far Altmetric has tracked 1,554 research outputs from this source. They typically receive a lot more attention than average, with a mean Attention Score of 20.9. This one has done well, scoring higher than 88% of its peers.
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We're also able to compare this research output to 51 others from the same source and published within six weeks on either side of this one. This one has done particularly well, scoring higher than 90% of its contemporaries.