Key result
Border zone channel mass is linked to ~6% higher risk of appropriate ICD therapy.
Why the study?
LVEF has limited arrhythmic specificity for ICD selection, and whether CMR-derived border zone and channel mass predict ventricular arrhythmias independently of LVEF, or involve mediation and interaction effects, needed evaluation.
Does cardiac magnetic resonance-derived border zone and channel mass predict appropriate ICD therapy independently of LVEF in ICD recipients?
Observational (n=168)
Does cardiac magnetic resonance-derived border zone and channel mass predict appropriate ICD therapy independently of LVEF in ICD recipients?
CMR-quantified border zone and conducting channel mass predict appropriate ICD therapy independently of LVEF, with the strongest association seen in patients with LVEF ≤30%, highlighting scar architecture as a key arrhythmic risk marker beyond systolic function.
Background Left ventricular ejection fraction (LVEF) remains the cornerstone for implantable cardioverter-defibrillator (ICD) selection, despite limited arrhythmic specificity. Cardiac magnetic resonance (CMR) enables detailed scar characterization, including border zone (BZ) tissue and conducting channels within dense scar. We evaluated whether BZ and channel mass predict ventricular arrhythmias independently of LVEF and explored mediation and interaction effects. Methods We conducted an observational study of 168 ICD recipients undergoing pre-implant CMR with quantitative scar analysis. BZ and channel mass were quantified using standardized post-processing (ADAS3D) (Figure 1). The primary endpoint was appropriate ICD therapy. Cox regression assessed associations between scar metrics and outcomes. LVEF adjustment evaluated mediation, and interaction terms tested effect modification by LVEF. Results Among 168 patients (60±12 years; 81% male; 46% ischemic; LVEF 38±17%), 31 (18%) experienced appropriate ICD therapy during a median follow-up of 34 months. BZ mass (HR 1.017, 95% CI 1.000–1.033; p=0.046) and channel mass (HR 1.063, 95% CI 1.011–1.118; p=0.016) were significantly associated with appropriate ICD therapy, whereas LVEF was not (HR 0.997, 95% CI 0.977–1.018; p=0.799). Although both scar metrics correlated inversely with LVEF, adjustment for LVEF did not attenuate their hazard ratios, indicating no evidence of mediation. A significant interaction was observed between channel mass and LVEF (p=0.030) (Table 1). Channel mass was strongly associated with arrhythmic events in patients with LVEF ≤30% (HR 1.16, 95% CI 1.07–1.25; p<0.001), and this association was significantly modified by LVEF (p for interaction=0.019). Conclusions Channel mass independently predicts ventricular arrhythmias. LVEF does not mediate this association but modifies its magnitude, underscoring scar architecture as a key arrhythmic risk marker beyond systolic function.
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Esplugues et al. (2026) conducted an observational in ICD recipients at risk for ventricular arrhythmias (n=168). Border zone channel mass and border zone mass on pre-implant CMR vs. Left ventricular ejection fraction (LVEF) was evaluated on Appropriate ICD therapy (HR 1.063, 95% CI 1.011-1.118, p=0.016). Border zone channel mass independently predicted appropriate ICD therapy (HR 1.063, 95% CI 1.011–1.118; p=0.016), particularly when LVEF ≤30% (HR 1.16; p<0.001).
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