Journal of the American Society of Echocardiography
Clinical InvestigationEchocardiographic Assessment of Myocardial ScarMyocardial Scar by Pulse-Cancellation Echocardiography Is Independently Associated with Appropriate Defibrillator Intervention for Primary Prevention after Myocardial Infarction
Section snippets
Study Design and Population
This study is a single-center retrospective case-control study, performed at the Parma University Medical Center, Parma, Italy.
We evaluated all patients (n = 268) who underwent ICD implantation for primary prevention of SCD because of severely reduced left ventricular (LV) systolic function (LV ejection fraction [LVEF] < 35%) after an angiographically confirmed MI between October 2008 and October 2017.
The inclusion criteria were (1) history of ischemic heart disease with at least one prior MI,
Results
Among the 50 subjects receiving at least one appropriate ICD shock, 34 (68%) had sustained ventricular tachycardia, while 16 (32%) were shocked for ventricular fibrillation. Mean time (±SD) between the index echocardiogram to either ICD discharge or final uneventful follow-up was 1,483.5 ± 919.5 days for cases and 1,595.9 ± 836.3 days for controls (P = .526).
Table 1 compares demographics, risk factors, medical history, and medical therapy data between the 50 cases and the 50 matched controls.
Discussion
The main finding of this study is that the presence and extent of myocardial scar, as determined by the eScar technique, is independently associated with appropriate ICD shocks in post-MI patients. Previous studies have also identified the presence and extent of myocardial scar as risk markers for SCD or ICD shocks, in patients with ischemic as well as in patients with nonischemic cardiomyopathy.1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12,20, 21, 22 However, most of these have employed CMR, which has
Conclusion
In this study a 2D multipulse echocardiography technique was used to detect the presence and extent of “eScar,” a surrogate ultrasound finding for myocardial scar. The extent of this eScar finding was associated with appropriate ICD discharges independent of demographic, clinical, and other echocardiography variables. In our study we could not demonstrate an incremental improvement in the association of the eScar with ICD discharge above that provided by clinical models comprising LVEDV.
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Cited by (7)
Detecting Scar in Echocardiography: Has the Power Shifted?
2022, Journal of the American Society of EchocardiographyPower Modulation Echocardiography to Detect and Quantify Myocardial Scar
2022, Journal of the American Society of EchocardiographyCitation Excerpt :Nevertheless, myocardial scar assessment by echocardiography is valuable and has been correlated to clinical outcomes. Gaibazzi et al.,30 using a pulse cancellation technique to detect scar, reported that the presence and extent of scar was significantly correlated with implantable cardioverter defibrillator therapies in a cohort of 50 patients after MI. Wang et al.31 found that the presence of myocardial scar affects LV diastolic function and adds incrementally to its association with mortality.
Recent Progresses in the Multimodality Imaging Assessment of Myocardial Fibrosis
2024, Reviews in Cardiovascular MedicinePost-myocardial infarction fibrosis: Pathophysiology, examination, and intervention
2023, Frontiers in PharmacologyPulse-Cancellation Echocardiography for Clinical Evaluation of Myocardial Scar Burden
2021, Current Cardiology Reports
Conflicts of Interest: None.