Sourabh Prabhakar

CAN THE FUNCTIONAL CAPACITY MEASURED BY DUKE ACTIVITY STATUS INDEX INCREASE THE VALUE OF IMAGING DURING STRESS TESTING

Determination of pretest probability of coronary artery disease (CAD) is recommended prior to noninvasive stress testing. The incidence of abnormal myocardial perfusion imaging (MPI) is reportedly very low in patients exercising >10 METs without ST depression. We sought to determine if prospectively

YIELD OF SERIAL STRESS MYOCARDIAL PERFUSION IMAGING IN THE EVALUATION OF RENAL TRANSPLANT POPULATION

A scientific statement from the ACC/AHA on kidney transplantation candidates stated that “The usefulness of periodically screening asymptomatic kidney transplantation candidates for myocardial ischemia while on the transplant waiting list to reduce the risk of MACEs is uncertain”. We sought to

DOES GRAY-ZONE LATE GADOLINIUM ENHANCEMENT ENRICH THE PREDICTION OF VENTRICULAR ARRHYTHMIA? A CARDIOVASCULAR MRI STUDY

Background: Sudden cardiac death in patients is predominantly caused by ventricular tachycardia (VT)/ventricular fibrillation (VF). Patients who have a low left ventricular ejection fraction (LVEF) and inducible VT during electrophysiologic study (EPS) are at risk of sudden death and may benefit from an implantable cardioverter-defibrillator (ICD) as do patients with low LVEF. However, LVEF’s primacy in predicted SCD has been questioned. Recently, cardiac MRI (CMR) has shown that a determination of myocardial core scar via late gadolinium enhancement (LGE) may predict VT/VF with greater precision than LVEF presumably due its ability to define likely sources of macro-rentry by delinieating the ‘gray-zone’ myocardium. We hypothesize that LGE depiction of gray-zone scar is more predictive of VT/VF than LGE core scar assessment.

Gray-zone late gadolinium enhancement greatly enriches the prediction of ventricular arrhythmia; a cardiovascular MRI study

Summary Gray-zone imaging for VT/VF is markedly predictive for both ischmic and non-ischemic patients as related to the incidence of post-implantation shock delivery. Background Sudden cardiac death in patients is predominantly caused by ventricular tachycardia (VT)/ventricular fibrillation (VF). Patients who have a low left ventricular ejection fraction (LVEF) and inducible VT during electrophysiologic study (EPS) are at risk of sudden death and may benefit from an implantable cardioverter-defibrillator (ICD) as do patients with low LVEF. However, LVEF’s primacy in predicted SCD has been questioned. Recently, cardiac MRI (CMR) has shown that a determination of myocardial core scar via late gadolinium enhancement (LGE) may predict VT/VF with greater precision than LVEF presumably due its ability to define likely sources of macro-rentry by delinieating the ‘grayzone’ myocardium. We hypothesize that LGE depiction of gray-zone scar is more predictive of VT/VF than LGE core scar assessment. Methods A consecutive, retrospective chart review was performed of patients with both a CMR exam for LGE and with post-CMR ICD implantation from 2006-2010 within 30 days. Demographic and clinical events were collected from patient charts and ICD interrogation. Standard LGE (>2SD) and gray-zone (LGE;2-3SD) was manually determined and related as a percent of LV mass to arrhythmic events and ICD therapy. Results