Home > Cardiology > EHRA 2022 > Diagnostics and Prevention > Cardiac magnetic resonance imaging improves prediction of post-MI sudden cardiac death

Cardiac magnetic resonance imaging improves prediction of post-MI sudden cardiac death

Presented by
Dr Nikolaos Dagres, Heart Center Leipzig, Germany
Conference
EHRA 2022
Trial
PROFID
Doi
https://doi.org/10.55788/d4d68d85
Cardiac magnetic resonance (CMR) imaging may improve the prediction of sudden cardiac death after myocardial infarction (MI). The first results of the updated PROFID clinical prediction model suggested that core scar and grey zone quantification add predictive value to the model. In future, CMR imaging may be used in conjunction with to left ventricular ejection fracture (LVEF) to predict the risk of sudden cardiac death in post-infarction patients.

The prevailing strategy to predict sudden cardiac death in post-infarction patients is based primarily on LVEF, explained Dr Nikolaos Dagres (Heart Center Leipzig, Germany) [1]. A major shortcoming of this approach is the lack of discriminative ability. A significant number of patients with an LVEF ≤35% may be overtreated, whereas patients who have an LVEF >35% may be undertreated [2]. PROFID aims to improve the predictive performance for sudden cardiac death, facilitating a personalised treatment approach.

Previously, a risk prediction tool was developed and tested based on data from 19 different datasets worldwide including 224,898 participants who had experienced a previous infarction or ischaemic cardiomyopathy with an LVEF <50%. The results showed that LVEF had a predictive value for sudden cardiac death in non-implantable cardioverter defibrillator (ICD) patients (area under the curve [AUC] 0.618), but other clinical characteristics or biomarkers did not improve the predictive performance of the model.

Dr Dagres presented the updated clinical risk prediction model, which included CMR data obtained from 2,049 participants >40 days after the infarction occurred. The first results of the updated model indicate that adding core scar size and grey zone size increased the predictive performance of the model at 12 months post-MI, especially in non-ICD patients (AUC 0.753). In patients with ICD, the 12-month post-MI AUC was 0.535 without CMR data and 0.598 with CMR data.

The PROFID risk model is still under investigation, but these results suggest that core scar size and grey zone size, as assessed by CMR imaging, may help clinicians to predict post-MI sudden cardiac death, particularly in those without traditional indications for prophylactic ICD. Importantly, improving the risk prediction for these patients may enable clinicians to offer a personalised-treatment approach based on this risk score.

  1. Dagres N, et al. Cardiac magnetic resonance imaging for prediction of risk for sudden cardiac death after myocardial infarction, the updated PROFID clinical prediction model. Late-breaking science 1, EHRA 2022, 3­–5 April, Copenhagen, Denmark.
  2. Dagres N, et al. Eur Heart J. 2020;41(39):3781‒3782.

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