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CarDiac magnEtic resonance for prophylactic implantable cardioVerter defibrillAtor ThErapy in ischemic dilated CardioMyopathy: Prognostic implication of papillary muscles involvement
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DOI：10.1016/j.pcad.2026.04.005.png)
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Abstract
En 中文
• Patients with ischemic cardiomyopathy (ICM) are at increased risk of sudden cardiac death as a result of malignant ventricular arrhythmias. Implantable cardioverter-defibrillators (ICDs) represent a life-saving therapy although it is not devoid of adverse effects and is associated with high costs. Accordingly, more refined diagnostic and prognostic instruments are required to delineate which patients are most likely to benefit from ICD therapy. Cardiac magnetic resonance (CMR) allows precise detection of myocardial scar tissue, including involvement of the papillary muscles, which may exert a pro-arrhythmogenic effect. • In a large international registry, we observed that scarring of the isolated posteromedial papillary muscle was associated with a higher risk of life-threatening arrhythmias. Importantly, among patients at intermediate risk according to the DERIVATE-ICM Score, the absence of papillary muscle scarring may identify a subgroup with lower risk. These findings should be interpreted with caution and considered exploratory, but may contribute to refining patient selection for ICD implantation as a preventive strategy pending further validation.
Keywords:
ischemic cardiomyopathy
implantable cardioverter-defibrillators
cardiac magnetic resonance
papillary muscle scarring
ventricular arrhythmias
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