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Comprehensive Prognosis Assessment in Heart Failure Using Imaging Techniques

Explore the significance of imaging in risk stratification for heart failure prognosis, focusing on arrhythmic and non-arrhythmic risks in ischemic and non-ischemic heart diseases. Learn about the predictive value of various imaging markers like myocardial fibrosis and extracellular volume fraction in determining patient outcomes.

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Comprehensive Prognosis Assessment in Heart Failure Using Imaging Techniques

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  1. L’imaging nella stratificazione prognostica dello scompenso cardiaco Gabriella Locorotondo, MD PhD U.O. Diagnostica Cardiologica Non Invasiva Fondazione Policlinico Universitario A. Gemelli Roma

  2. Does LV EF matterforriskstratification? Whichrisk? (arrhythmic / non-arrhythmic)

  3. Benefit more for SCD in ischemicheartdisease and NYHA II. In non-ischemicheartdisease and NYHA class III no differencesbetween ICD and placebo

  4. CMR and myocardialfibrosis

  5. Comprehensive Prognosis Assessment by CMR Imaging In Ischemic Heart Disease Eitel I, JACC 2014

  6. Prediction of Life-Threatening Arrhythmic Events in Chronic Ischemic DCM Single-center prospective study in 52 pts with chronic ischemic DCM (> 40 days after MI), candidated to ICD implantation according to MADIT I and II criteria Boyè P, JACC Cardiovascular Imaging 2011

  7. Should infarct size enter guidelines criteria?... Gaps in knowledge Boyè P, JACC Cardiovascular Imaging 2011

  8. T1-mapping and Extracellular volume

  9. Native T1 Value in the Remote Myocardium Is Independently Associated With LV Dysfunction in Patients With Prior MI Nakamori S, J Cardiovasc Magn Reson 2017

  10. 58% in both group had CRT

  11. CMR in non-ischemic DCM Gulati A, Pennell JD, Prasad S, JAMA 2013

  12. Late Gadolinium Enhancement and the Risk for VAs or SCD in Non-ischemic DCM 2,948 patients from 29 studies – Mean age 60 years - LVEFs: 20%-43% - Follow-up: 1-5.3 years Di Marco et al JACC Heart Failure 2017

  13. Association Between Mid-Wall LGE and SCD in DCM and Mild-Moderate LV Systolic Dysfunction A LGE extent cut-off of >0% was the best discriminator of event-free survival time Halliday BP, Circulation 2017

  14. Presence of Mid-Wall Fibrosis predicts efficacy of CRT-D vs CRT-P in NonischemicCardiomyopathy Leyva F, JACC 2017

  15. Cardiac Magnetic Resonance GUIDEd Management of Mild-moderate Left Ventricular Systolic Dysfunction (CMR_GUIDE trial) Prospective randomized, placebo-controlled trial of primary prophylaxis ICD therapy or implantable loop recorder insertion in patients with LVEF 36-50% and LGE on CMR Controls: prospective observational registry of patients with LVEF 36-50% and no LGE on CMR 1055 pts (700 in Australia and 355 in Germany and United Kingdom) Inclusion criteria: patients with CAD or non-ischemic cardiomyopathy (idiopathic, chronic post-myocarditis) on maximum tolerated doses of ACE inhibitors/ARBs and beta-blockers 36 months follow-up Primary end-point: SCD or VT leading to syncope Secondary outcome measures: SCD, syncopal VT, all-cause mortality, NYHA class, QoL, HF-related hospitalization, health economic evaluation costs Start Date: July 2015 Estimated completion date: March 2022 NCT01918215

  16. Role of GLS in HFpEF Smiseth OA, Eur Heart J 2016

  17. Extracellular Volume Fraction for Characterization of Patients With HFpEF Rommel, JACC 2016

  18. Interstitial Fibrosis, Functional Status, and Outcomes in HFPEF Duca F, Circ Cardiovasc Imaging. 2016

  19. Prognostic value of stress E/e’ and PH Chi Young Shim, Heart 2011

  20. Prognostic role of RV Dysfunction in HF: superiority of RV free waal strain over TAPSE Carluccio E, Circ Cardiovasc Imaging. 2018

  21. Towards a personalizedprecision medicine

  22. We must remember to treat the patient and not the disease or the echocardiogram Grazie per l’attenzione Gabriella Locorotondo, MD PhD U.O. Diagnostica Cardiologica Non Invasiva gabriella.locorotondo@policlinicogemelli.it

  23. Impaired GLS and risk of SCD and non-sudden cardiac death Courtesy of Paiman EHM, Department of Radiology – Leiden University Medical Center, The Netherlands

  24. T1 mapping-based ECV independently predicts clinical outcome in non-ischemic DCM 117 patients Mean age 51.9 Youn JC, Eur Rad 2017

  25. CarDiacMagnEtic Resonance for Primary Prevention Implantable CardioVerterDefibrillAtorThErapy: an International Registry (DERIVATE) Multicenter prospective observational cohort study to: - determine CMR findings (LGE, T1, ECV) that predict SCD and Vas - provide a comprehensive clinical and imaging score that effectively improves selection of patients who deserve a prophylactic ICD therapy. 4000 pts Inclusion criteria: patients with ischemic or non-ischemic DCM (LVEF < 55%) Target follow-up duration: minimum 12 moths Primary end-point: all-cause mortality Secondary outcome measures: SCD, HF death, sustained VTs, MACE, composite end-points Start Date: January 2010 Estimated completion date: March 2018 NCT003352648

  26. Predictingsurvival in heartfailurebyriskscores 39 372 patients from 30 studies (6 RCTs, 24 registries). 15 851 (40.2%) patients died during a median follow-up of 2.5 years http://www.heartfailurerisk.org Pocock SJ, Eur Heart J 2013

  27. GLS and ECV are independent diagnostic markers of HFpEF Mordi, JACC Cardiovasc Imaging. 2017

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