Magnetic resonance estimates of the extent and heterogeneity of scar tissue in ICD patients with ischemic cardiomyopathy predict ventricular arrhythmia

Tawfiq Zeidan-Shwiri, Yuesong Yang, Ilan Lashevsky, Ehud Kadmon, Darren Kagal, Alexander Dick, Avishag Laish Farkash, Gideon Paul, Donsheng Gao, Mohammed Shurrab, David Newman, Graham Wright, Eugene Crystal

Research output: Contribution to journalArticlepeer-review

28 Scopus citations


Background The majority of patients receiving implantable cardioverter-defibrillator (ICD) implantation under current guidelines never develop sustained ventricular arrhythmia; therefore, better markers of risk for sustained ventricular tachycardia and/or ventricular fibrillation are needed. Objective The purpose of this study was to identify cardiac magnetic resonance arrhythmic risk predictors of ischemic cardiomyopathy before ICD implantation. Methods Forty-three subjects (mean age, 64.5 ± 11.9 years) with previous myocardial infarction who were referred for ICD implantation were evaluated by cardiac magnetic resonance imaging (MRI). The MRI protocol included left ventricular functional parameter assessment using steady-state free precession and late gadolinium enhancement MRI using inversion recovery fast gradient echo. Left ventricular functional parameters were measured using cardiac magnetic resonance software. Subjects were followed up for 6-46 months, and the events of appropriate ICD treatments (shocks and antitachycardia pacing) were recorded. Results Twenty-eight patients experienced 46 spontaneous episodes during a median follow-up duration of 30 months. The total myocardial infarct (MI) size (18.05 ± 11.44 g vs 38.83 ± 19.87 g; P =.0006), MI core (11.63 ± 7.14 g vs 24.12 ± 12.73 g; P =.0002), and infarct gray zone (6.43 ± 4.64 g vs 14.71 ± 7.65 g; P =.0004) were significantly larger in subjects who received appropriate ICD therapy than in those who did not experience an episode of ventricular tachycardia and/or ventricular fibrillation. Multivariate regression analyses for the infarct gray zone and MI core adjusted for New York Heart Association class, diabetes, and etiology (primary or secondary prevention) revealed that the gray zone and MI core were predictors of appropriate ICD therapies (P =.0018 and P =.007, respectively). Conclusion The extent of MI scar may predict which patients would benefit most from ICD implantation.

Original languageEnglish
Pages (from-to)802-808
Number of pages7
JournalHeart Rhythm
Issue number4
StatePublished - 1 Apr 2015
Externally publishedYes


  • Cardiac magnetic resonanceimaging
  • Grayzone
  • Implantable cardioverter-defibrillator
  • Infarctcore
  • Ventricular fibrillation
  • Ventriculartachycardia

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)


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