Cardiac MRI Based Left Ventricular Global Function Index: Association with Disease Severity in Patients with ICD for Secondary Prevention

Left ventricular (LV) ejection fraction (LVEF) is the most widely used prognostic marker in cardiovascular diseases. LV global function index (LVGFI) is a novel marker which incorporates the total LV structure in the assessment of LV cardiac performance. We evaluated the prognostic significance of L...

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Autores principales:	Andreas Leonhard Schober, Carsten Jungbauer, Florian Poschenrieder, Alexander Daniel Schober, Ute Hubauer, Andreas Keyser, Sabine Fredersdorf-Hahn, Kurt Debl, Lars S. Maier, Samuel Sossalla, Stefan Buchner, Ekrem Üçer
Formato:	article
Lenguaje:	EN
Publicado:	MDPI AG 2021
Materias:	ICD heart failure cardiac arrest cardiac magnetic resonance ejection Medicine R
Acceso en línea:	https://doaj.org/article/6fcee0ca09cf470d9d67dca2aecf44db
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spelling	oai:doaj.org-article:6fcee0ca09cf470d9d67dca2aecf44db2021-11-11T17:36:38ZCardiac MRI Based Left Ventricular Global Function Index: Association with Disease Severity in Patients with ICD for Secondary Prevention10.3390/jcm102149802077-0383https://doaj.org/article/6fcee0ca09cf470d9d67dca2aecf44db2021-10-01T00:00:00Zhttps://www.mdpi.com/2077-0383/10/21/4980https://doaj.org/toc/2077-0383Left ventricular (LV) ejection fraction (LVEF) is the most widely used prognostic marker in cardiovascular diseases. LV global function index (LVGFI) is a novel marker which incorporates the total LV structure in the assessment of LV cardiac performance. We evaluated the prognostic significance of LVGFI, measured by cardiovascular magnetic resonance (CMR), in predicting mortality and ICD therapies in a real-world (ICD) population with secondary ICD prevention indication, to detect a high-risk group among these patients. In total, 105 patients with cardiac MRI prior to the ICD implantation were included (mean age 56 ± 16 years old; 76% male). Using the MRI data for each patient LVGFI was determined and a cut-off for the LVGFI value was calculated. Patients were followed up every four to six months in our or clinics in proximity. Data on the occurrence of heart failure symptoms and or mortality, as well as device therapies and other vital parameters, were collected. Follow up duration was 37 months in median. The mean LVGFI was 24.5%, the cut off value for LVGFI 13.5%. According to the LVGFI Index patient were divided into 2 groups, 86 patients in the group with the higher LVGFI und 19 patients in the lower group. The LVGFI correlates significantly with the LVEF (<i>r</i> = 0.642, <i>p</i> < 0.001). In Kaplan–Meier analysis, a lower LVGFI (<13.5%) was associated with a higher rate of mortality and rehospitalization (<i>p</i> = 0.002). In contrast, echocardiographic LVEF ≤ 33% was not associated with a higher rate of mortality or rehospitalization. Multivariate Cox-regression analysis revealed a lower LVGFI (<i>p</i> = 0.025, HR = 0.941; 95%-CI 0.89–0.99) and diabetes mellitus (<i>p</i> = 0.027, HR = 0.33; 95%-CI 0.13–0.88) as an independent predictor for mortality and rehospitalization. There was no association between the combined endpoint and the LVEF<sub>MRT</sub>, LVEF<sub>echo</sub>, NYHA > I, the initial device or a medication (each <i>p</i> = n.s.). Further, in Kaplan–Meier analysis no association was evident between the LVGFI and adequate ICD therapy (<i>p</i> = n.s.). In secondary prevention ICD patients reduced LVGFI was shown as an independent predictor for mortality and rehospitalization, but not for ICD therapies. We were able to identify a high-risk collective among these patients, but further investigation is needed to evaluate LVGFI compared to ejection fraction, especially in patients with an elevated risk for adverse cardiac events.Andreas Leonhard SchoberCarsten JungbauerFlorian PoschenriederAlexander Daniel SchoberUte HubauerAndreas KeyserSabine Fredersdorf-HahnKurt DeblLars S. MaierSamuel SossallaStefan BuchnerEkrem ÜçerMDPI AGarticleICDheart failurecardiac arrestcardiac magnetic resonanceejectionMedicineRENJournal of Clinical Medicine, Vol 10, Iss 4980, p 4980 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	ICD heart failure cardiac arrest cardiac magnetic resonance ejection Medicine R
spellingShingle	ICD heart failure cardiac arrest cardiac magnetic resonance ejection Medicine R Andreas Leonhard Schober Carsten Jungbauer Florian Poschenrieder Alexander Daniel Schober Ute Hubauer Andreas Keyser Sabine Fredersdorf-Hahn Kurt Debl Lars S. Maier Samuel Sossalla Stefan Buchner Ekrem Üçer Cardiac MRI Based Left Ventricular Global Function Index: Association with Disease Severity in Patients with ICD for Secondary Prevention
description	Left ventricular (LV) ejection fraction (LVEF) is the most widely used prognostic marker in cardiovascular diseases. LV global function index (LVGFI) is a novel marker which incorporates the total LV structure in the assessment of LV cardiac performance. We evaluated the prognostic significance of LVGFI, measured by cardiovascular magnetic resonance (CMR), in predicting mortality and ICD therapies in a real-world (ICD) population with secondary ICD prevention indication, to detect a high-risk group among these patients. In total, 105 patients with cardiac MRI prior to the ICD implantation were included (mean age 56 ± 16 years old; 76% male). Using the MRI data for each patient LVGFI was determined and a cut-off for the LVGFI value was calculated. Patients were followed up every four to six months in our or clinics in proximity. Data on the occurrence of heart failure symptoms and or mortality, as well as device therapies and other vital parameters, were collected. Follow up duration was 37 months in median. The mean LVGFI was 24.5%, the cut off value for LVGFI 13.5%. According to the LVGFI Index patient were divided into 2 groups, 86 patients in the group with the higher LVGFI und 19 patients in the lower group. The LVGFI correlates significantly with the LVEF (<i>r</i> = 0.642, <i>p</i> < 0.001). In Kaplan–Meier analysis, a lower LVGFI (<13.5%) was associated with a higher rate of mortality and rehospitalization (<i>p</i> = 0.002). In contrast, echocardiographic LVEF ≤ 33% was not associated with a higher rate of mortality or rehospitalization. Multivariate Cox-regression analysis revealed a lower LVGFI (<i>p</i> = 0.025, HR = 0.941; 95%-CI 0.89–0.99) and diabetes mellitus (<i>p</i> = 0.027, HR = 0.33; 95%-CI 0.13–0.88) as an independent predictor for mortality and rehospitalization. There was no association between the combined endpoint and the LVEF<sub>MRT</sub>, LVEF<sub>echo</sub>, NYHA > I, the initial device or a medication (each <i>p</i> = n.s.). Further, in Kaplan–Meier analysis no association was evident between the LVGFI and adequate ICD therapy (<i>p</i> = n.s.). In secondary prevention ICD patients reduced LVGFI was shown as an independent predictor for mortality and rehospitalization, but not for ICD therapies. We were able to identify a high-risk collective among these patients, but further investigation is needed to evaluate LVGFI compared to ejection fraction, especially in patients with an elevated risk for adverse cardiac events.
format	article
author	Andreas Leonhard Schober Carsten Jungbauer Florian Poschenrieder Alexander Daniel Schober Ute Hubauer Andreas Keyser Sabine Fredersdorf-Hahn Kurt Debl Lars S. Maier Samuel Sossalla Stefan Buchner Ekrem Üçer
author_facet	Andreas Leonhard Schober Carsten Jungbauer Florian Poschenrieder Alexander Daniel Schober Ute Hubauer Andreas Keyser Sabine Fredersdorf-Hahn Kurt Debl Lars S. Maier Samuel Sossalla Stefan Buchner Ekrem Üçer
author_sort	Andreas Leonhard Schober
title	Cardiac MRI Based Left Ventricular Global Function Index: Association with Disease Severity in Patients with ICD for Secondary Prevention
title_short	Cardiac MRI Based Left Ventricular Global Function Index: Association with Disease Severity in Patients with ICD for Secondary Prevention
title_full	Cardiac MRI Based Left Ventricular Global Function Index: Association with Disease Severity in Patients with ICD for Secondary Prevention
title_fullStr	Cardiac MRI Based Left Ventricular Global Function Index: Association with Disease Severity in Patients with ICD for Secondary Prevention
title_full_unstemmed	Cardiac MRI Based Left Ventricular Global Function Index: Association with Disease Severity in Patients with ICD for Secondary Prevention
title_sort	cardiac mri based left ventricular global function index: association with disease severity in patients with icd for secondary prevention
publisher	MDPI AG
publishDate	2021
url	https://doaj.org/article/6fcee0ca09cf470d9d67dca2aecf44db
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Cardiac MRI Based Left Ventricular Global Function Index: Association with Disease Severity in Patients with ICD for Secondary Prevention

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