Cardiac Magnetic Resonance for Prophylactic Implantable-Cardioverter Defibrillator Therapy in Ischemic Cardiomyopathy: The DERIVATE–ICM International Registry

Gianluca Pontone*, Andrea Igoren Guaricci, Laura Fusini, Andrea Baggiano, Marco Guglielmo, Giuseppe Muscogiuri, Alessandra Volpe, Raffaele Abete, Giovanni Aquaro, Andrea Barison, Jan Bogaert, Giovanni Camastra, Samuela Carigi, Nazario Carrabba, Grazia Casavecchia, Stefano Censi, Gloria Cicala, Carlo N. De Cecco, Manuel De Lazzari, Gabriella Di GiovineMauro Di Roma, Monica Dobrovie, Marta Focardi, Nicola Gaibazzi, Annalaura Gismondi, Matteo Gravina, Chiara Lanzillo, Massimo Lombardi, Valentina Lorenzoni, Jordi Lozano-Torres, Chiara Martini, Francesca Marzo, Ambra Masi, Riccardo Memeo, Claudio Moro, Alberto Nese, Alessandro Palumbo, Anna Giulia Pavon, Patrizia Pedrotti, Martina Perazzolo Marra, Silvia Pica, Silvia Pradella, Cristina Presicci, Mark G. Rabbat, Claudia Raineri, José F. Rodriguez-Palomares, Stefano Sbarbati, U. Joseph Schoepf, Angelo Squeri, Nicola Sverzellati, Rolf Symons, Emily Tat, Mauro Timpani, Giancarlo Todiere, Adele Valentini, Akos Varga-Szemes, Pier Giorgio Masci, Juerg Schwitter

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

4 Citations (Scopus)


Background: Implantable cardioverter-defibrillator (ICD) therapy is the most effective prophylactic strategy against sudden cardiac death (SCD) in patients with ischemic cardiomyopathy (ICM) and left ventricle ejection fraction (LVEF) ≤35% as detected by transthoracic echocardiograpgy (TTE). This approach has been recently questioned because of the low rate of ICD interventions in patients who received implantation and the not-negligible percentage of patients who experienced SCD despite not fulfilling criteria for implantation. Objectives: The DERIVATE-ICM registry (CarDiac MagnEtic Resonance for Primary Prevention Implantable CardioVerter DebrillAtor ThErapy; NCT03352648) is an international, multicenter, and multivendor study to assess the net reclassification improvement (NRI) for the indication of ICD implantation by the use of cardiac magnetic resonance (CMR) as compared to TTE in patients with ICM. Methods: A total of 861 patients with ICM (mean age 65 ± 11 years, 86% male) with chronic heart failure and TTE-LVEF <50% participated. Major adverse arrhythmic cardiac events (MAACE) were the primary endpoints. Results: During a median follow-up of 1,054 days, MAACE occurred in 88 (10.2%). Left ventricular end-diastolic volume index (HR: 1.007 [95% CI: 1.000-1.011]; P = 0.05), CMR-LVEF (HR: 0.972 [95% CI: 0.945-0.999]; P = 0.045) and late gadolinium enhancement (LGE) mass (HR: 1.010 [95% CI: 1.002-1.018]; P = 0.015) were independent predictors of MAACE. A multiparametric CMR weighted predictive derived score identifies subjects at high risk for MAACE compared with TTE-LVEF cutoff of 35% with a NRI of 31.7% (P = 0.007). Conclusions: The DERIVATE-ICM registry is a large multicenter registry showing the additional value of CMR to stratify the risk for MAACE in a large cohort of patients with ICM compared with standard of care.

Original languageEnglish
Pages (from-to)1387-1400
Number of pages14
JournalJACC: Cardiovascular Imaging
Issue number11
Publication statusPublished - Nov 2023


  • cardiac magnetic resonance
  • heart failure
  • implantable cardioverter-defibrillator
  • ischemic dilated cardiomyopathy
  • primary prevention

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