BACKGROUND: Annually,    80,000 Americans receive guideline-based primary prevention @entity737 ( @entity737 ), but appropriate firing rates are low. Current selection criteria for @entity737 rely on left ventricular ejection fraction, which lacks sensitivity and specificity. Because scar-related myocardial tissue heterogeneity is a substrate for life-threatening @entity943 , we hypothesized that cardiac magnetic resonance identification of myocardial heterogeneity improves risk stratification through (1) its association with adverse @entity299 independent of clinical factors and biomarker levels and (2) its ability to identify particularly high- and low-risk subgroups. METHODS AND RESULTS: In 235 @entity1 with chronic @entity296 with a left ventricular ejection fraction of  <=35% undergoing clinically indicated primary prevention @entity1479 implantation, @entity2287 -enhanced cardiac magnetic resonance was prospectively performed to quantify the amount of heterogeneous myocardial tissue (gray zone [GZ]) and dense core scar. Serum high-sensitivity @entity1851 (hsCRP) and other biomarkers were assayed. The primary end point was appropriate @entity1479 shock for @entity2224 or @entity204 , which occurred in 45 (19%) @entity1 at a 3.6-year median follow-up. On univariable analysis, only diuretics, hsCRP, GZ, and core scar were associated with outcome. After multivariable adjustment, GZ and hsCRP remained independently associated with outcome (P<0.001). @entity1 in the lowest tertile for both GZ and hsCRP (n=42) were at particularly low risk (0.7% per year event rate), whereas those in the highest tertile for both GZ and hsCRP (n=32) had an event rate of 16.1% per year, P<0.001. CONCLUSIONS: In a cohort of primary prevention @entity1479 candidates, combining a myocardial heterogeneity index with an inflammatory biomarker identified a subgroup with a very low risk for adverse @entity299 , including @entity943 . This novel approach warrants further investigation to confirm its value as a clinical risk stratification tool. Clinical Trial Registration- URL: http://www.clinicaltrials.gov. Unique identifier: NCT00181233.

Combined cardiac magnetic resonance imaging and XXXX levels identify a cohort at low risk for defibrillator firings and @entity204 .

@entity1 :: ('9606', 'Species') :: ['Patients', 'patients'] @entity1479 :: ('OMIM:252500', 'Disease') :: ['ICD'] @entity296 :: ('MESH:D009202', 'Disease') :: ['ischemic and nonischemic cardiomyopathy'] @entity737 :: ('MESH:D057873', 'Disease') :: ['implantable cardioverter-defibrillators', 'ICDs'] @entity2287 :: ('MESH:D005682', 'Chemical') :: ['gadolinium'] @entity2224 :: ('MESH:D014693', 'Disease') :: ['ventricular tachycardia/fibrillation'] @entity299 :: ('MESH:D006331', 'Disease') :: ['cardiac events'] @entity943 :: ('MESH:D001145', 'Disease') :: ['ventricular arrhythmias', 'arrhythmias'] @entity204 :: ('MESH:D003643', 'Disease') :: ['cardiac death'] @entity1851 :: ('1401', 'Gene') :: ['C-reactive protein']
@entity1851 :: (1401,Gene) :: ['C-reactive protein']
