Implantable cardioverter defibrillator implantation and degree of left ventricular scarring predict survival in patients with severe ischemic cardiomyopathy

Methods Patients (n = 337) with ≥ 70% disease in ≥1 epicardial coronary artery (77% men, median age 66 years, median LV ejection fraction [EF] of 22 %) undergoing CMR (Siemens 1.5-T scanner, Erlangen, Germany) between 2003-2007 were studied. CMR evaluation included long and short axis assessment of LV function on steady state free precession cine images along with assessment of myocardial scar (on inversion recovery DHE-CMR sequence ~ 10-20 minutes after injection of 0.2 mmol/ kg of Gadolinium dimeglumine). Scar was identified as regions of interest > 2 SD above normal myocardium. LV scar was categorized based on mean scar % and transmural extent (0 = none, 1 = 1-25%, 2 = 26-50%, 3 = 51-75%, and 4 = > 75%). Total scar score was determined from the summed scar score of 17 segments per patient divided by 17. 94 patients underwent subsequent ICD implantation. The composite end-point was cardiac transplantation and all-cause mortality. Results: Over a follow-up of up to 8 years, there were 107 events (102 deaths, 5 cardiac transplantations). Receiver operating characteristic curve analysis was used to select the optimum threshold of mean scar % ≥ 33%, total scar score ≥ 2.3 to predict death/transplantation. On multivariate variate analysis, only age, total scar score, diabetes, gender, and ICD implantation were independent predictors of mortality/transplantation (Table 1). ICD