@Vortexium32
www.tctmd.com Scarring Doesn’t Tip the Scale Towards ICDs in Cardiomyopathy With LVEF of 36-50% The CMR GUIDE trial didn’t meet its primary endpoint but did point to possible positives, especially in younger patients. 💬 Editorial by Sana Al-Khatib, MD, MHS: Left ventricular ejection fraction alone may not adequately identify patients at risk of sudden cardiac death, and cardiovascular magnetic resonance may refine risk assessment in those w/ left ventricular ejection fraction >35%.
🔗 ja.ma/4cjTyPw
#ESCCongress @escardioView quoted post on X
#CMRGUIDE at #ESCCongress
Should myocardial SCAR—not just EF—help determine who gets a primary-prevention ICD?
Patients with:
➡️ LVEF 36–50%
➡️ Ischemic or nonischemic cardiomyopathy
➡️ Scar/fibrosis on CMR
Randomized 353 pt, impacted by COVID, 82% Men
⏱️6.3 y
ICD vs implantable loop recorder
Primary Endpoint= SCD or hemodynamically significant ventricular arrhythmia
🌟RESULTS:
Primary: SCD or hemodynamically significant ventricular arrhythmia
➡️ HR 0.76 (95% CI 0.37–1.58), P=.47 ❌
Sudden cardiac death alone:
➡️ HR 0.26 (0.07–0.95), P=.04
All-cause mortality:
➡️ HR 0.91 (0.49–1.71), P=.78
🫀 CMR-guided ICD implantation did not reduce the primary composite endpoint. The reduction in SCD is intriguing, but as a secondary endpoint in a negative trial it should be interpreted cautiously.
CMR scar alone does not yet appear sufficient to expand ICD indications beyond current EF-based criteria.
📄 jamanetwork.com/journals/jama/… @JAMA_current
#WhyCMR #CardioTwitter #EPeeps #HeartFailureView quoted post on X
Among patients with ischemic or nonischemic cardiomyopathy, left ventricular ejection fraction of 36% to 50%, and myocardial scar on #CardiovascularMagneticResonance, implantation of an implantable cardioverter-defibrillator did not significantly reduce sudden cardiac death or hemodynamically significant ventricular arrhythmia vs an implantable loop recorder. Rates of all-cause mortality, cardiovascular mortality, and heart failure–related hospitalization were also similar between groups. #ESCCongress ja.ma/46rkSI4View quoted post on X
Among patients with ischemic or nonischemic cardiomyopathy, left ventricular ejection fraction of 36% to 50%, and myocardial scar on #CardiovascularMagneticResonance, implantation of an implantable cardioverter-defibrillator did not significantly reduce sudden cardiac death or hemodynamically significant ventricular arrhythmia vs an implantable loop recorder. Rates of all-cause mortality, cardiovascular mortality, and heart failure–related hospitalization were also similar between groups. #ESCCongress ja.ma/4gvoZHOView quoted post on X
