Rapid Fire Abstracts
Karolina M. Zareba, MD
Associate Professor
The Ohio State University
Karolina M. Zareba, MD
Associate Professor
The Ohio State University
Suzanne Smart, BSc, CCRP
Research Associate
The Ohio State University
Matthew A. Bernabei, MD
Cardiologist
Penn Medicine Lancaster General Health
Chetan Shenoy, MBBS, MS
MD
Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
Madhu Reddy, MD
Professor of Medicine
The University of Kansas Health System
Samuel Johnston, MD
Assistant Professor
University of Iowa
Srinivas Rajsheker, MD
Associate Professor
University of Cincinnati
Muhammad R. Afzal, MD
Assistant Professor
The Ohio State University
Mayer Rashtian, MD
Cardiologist
Huntington Memorial Hospital
Peter Santucci, MD
Professor
Loyola University Medical Center
David Huang, MD
Professor of Medicine
University of Rochester Medical Center
Stephen Winters, MD
Cardiologist
Morristown Medical Center
Kristina Cutter, MSc
Research Associate
University of Rochester Medical Center
Scott McNitt, MSc
Senior Associate
University of Rochester Medical Center
Bronislava Polonsky, MSc
Senior Analyst
University of Rochester Medical Center
Wojciech Zareba, MD, PhD
Professor of Medicine
University of Rochester Medical Center
Risk stratification in nonischemic cardiomyopathy (NICM) remains a challenge. Current guidelines for device implantation are based on left ventricular ejection fraction (LVEF) and QRS duration. The aim of the MARVEN study (Clinical, Electrocardiographic, and Cardiac Magnetic Resonance Imaging Risk Factors Associated with Ventricular Tachyarrhythmias in Nonischemic Cardiomyopathy) was to evaluate clinical and imaging models for predicting ventricular arrhythmias in patients undergoing cardiac resynchronization therapy defibrillator (CRT-D) or implantable cardioverter defibrillator (ICD) implantation. The purpose of the current analysis was to evaluate sex differences in NICM patients presenting for device implant.
Methods:
NICM patients scheduled for CRT-D or ICD implantation were recruited across 27 participating US sites and underwent Holter monitoring and CMR exams with cine and late gadolinium enhancement (LGE) imaging prior to device implant. All image analysis was performed at the CMR Core Lab with validated software (cvi42, Circle Cardiovascular Imaging, Calgary). LGE presence, location, and extent (by AHA segments) were evaluated. LGE was deemed to be present if identified in two contiguous slices or two orthogonal planes; isolated right ventricular insertion site fibrosis was excluded. The primary endpoint consisted of ventricular tachycardia/fibrillation (VT/VF) >188 bpm on device check; secondary endpoint included VT/VF >188 bpm or death.
Results: A total of 303 patients (mean age 60±13 years, 52% female) were included in the final analysis. CRT-Ds were implanted in 225 patients (74%); whereas ICDs in 72 patients (24%). The mean LVEF was 24±6%, with 42% of patients having NYHA class III. Males had larger indexed LV and right ventricular (RV) volumes and LV mass as compared to females (Table 1). RV function was significant worse in males. The overall prevalence of LGE was high in this cohort (78%), with males exhibiting higher LGE burden vs females (p< 0.001). There were no significant differences in age, history of heart failure hospitalization, LVEF, NYHA class, or type of device implanted between sexes. Overall rates of guideline-directed medical therapies (GDMT) were high and similar between sexes. During a mean follow up of 30±16 months, males had a higher incidence of VT/VF >188 bpm than females (10% vs 3%, p=0.02) (Figure 1). In this cohort of frequent GDMT and CRT-D use rates of death were low and similar between sexes.
Conclusion: In a contemporary cohort of NICM patients, treated with guideline directed medical therapy and undergoing device implantation, sex differences remain in CMR characteristics and outcomes. Males have more ventricular remodeling despite similar EF, worse RV function, higher prevalence of LGE, and higher incidence of ventricular arrhythmias. Future studies are needed to determine the need for sex-based approaches in risk stratification of NICM patients.
