The prognostic value of cardiovascular magnetic resonance in aborted sudden cardiac death
Bibliographic record
Abstract
Aborted sudden cardiac death (SCD) is a common indication for CMR. No studies have investigated the prognostic value of late gadolinium enhancement (LGE) solely in patients with secondary prevention implantable cardioverter-defibrillators (ICD) or aborted SCD. 58 consecutive patients who had CMR and ICD implantation after aborted SCD between 2006 and 2013 were identified. Clinical notes and CMR results were reviewed. Patients were scanned with a CMR protocol that included a short axis cine stack and LGE imaging. CMR images were analysed blinded to clinical data using standard software (cvi42, Circle CVI, Canada). Patients were followed up after ICD implantation at six weeks, three months and six months and then every six months. Appropriate ICD therapy was defined as any anti-tachycardia pacing (ATP) or shock therapy delivered for a ventricular arrhythmia. Follow up data was available on 55/58 patients. Four patients died during the follow up period and one patient was lost to follow up 14 days post-implantation. Median follow up was 791 days (interquartile range 370-1142 days). 11 patients had appropriate ICD therapy. 6 had ATP only and 5 had appropriate shocks ±ATP for ventricular arrhythmias. The clinical aetiology of the aborted SCD was ischaemic heart disease (IHD) 24, primary arrhythmia 14, arrhythmogenic right ventricular cardiomyopathy 7, dilated cardiomyopathy 6, myocarditis 2 and other 5. Of 55 patients on whom clinical outcome data was available 20 patients had ejection fraction (EF)<35% and 35 had EF>35%. 5/20 (25%) of those with EF<35% had appropriate ICD therapies and 6/35 (17%) of those with EF>35% had appropriate ICD therapies on follow up. There was no significant difference in the likelihood ratio (LR) of appropriate therapy using an EF cutoff of 35% (LR 0.48, P=0.49), confirmed on log rank analysis of Kaplan Meier curves (figure 1 ) (P=0.32). Kaplan Meier curves showing freedom from appropriate ICD therapy with patients stratified according to presence of LGE (above) and EF (below). Each horizontal line represents a censored subject. Of the 52 patients who had LGE imaging and clinical outcome data 32 had LGE present and 20 had no LGE. 10/32 (31%) LGE +ve patients had appropriate ICD therapies on follow up and only 1/20 (5%) LGE-ve patients had appropriate ICD therapies. LGE +ve patients were significantly more likely to have an appropriate ICD therapy on follow up (LR 5.97, P=0.015), confirmed on log rank analysis of Kaplan Meier curves (P=0.036). In patients who have suffered aborted SCD, CMR is able to identify patients at risk of future arrhythmic events according to the presence or absence of LGE.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".