The Extent of Left Ventricular Scar Quantified by Late Gadolinium Enhancement MRI Is Associated With Spontaneous Ventricular Arrhythmias in Patients With Coronary Artery Disease and Implantable Cardioverter-Defibrillators
- 1 June 2011
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Circulation: Arrhythmia and Electrophysiology
- Vol. 4 (3), 324-330
- https://doi.org/10.1161/circep.110.959544
Abstract
Background—: Characterization of sudden cardiac death (SCD) risk remains a challenge in the application of implantable cardioverter-defibrillator (ICD) therapy. Late gadolinium enhancement cardiac MRI (LGE-CMR) can accurately identify myocardial scar. We performed a retrospective, single-center observational study to evaluate the association between the extent and distribution of left ventricular scar, quantified using LGE-CMR, and the burden of ventricular arrhythmias in patients with coronary artery disease and ICDs. Methods and Results—: All patients included (2006 to 2009) had undergone LGE-CMR before ICD implantation. Scar (defined as myocardium with a signal intensity ≥50% of the maximum in scar tissue) was characterized in terms of percent scar, scar surface area, and number of transmural left ventricular scar segments. The end point was appropriate ICD therapy. Sixty-four patients (mean age, 66±11 years; male sex, 51) were included. During 19±10 months follow-up, appropriate ICD therapy occurred in 19 (30%) patients. In Cox regression analyses, both percent scar (hazard ratio per 10%, 1.75; 95% CI, 1.09 to 2.81; P =0.02) and number of transmural scar segments (hazard ratio per segment, 1.40; 95% CI, 1.15 to 1.70; P =0.001) were significantly associated with the occurrence of appropriate ICD therapy. Conclusions—: In this pilot study, the extent of myocardial scar characterized by LGE-CMR was significantly associated with the occurrence of spontaneous ventricular arrhythmias. We hypothesize that scar quantification by LGE-CMR may prove a valuable risk stratification tool for the occurrence of ventricular arrhythmias, which may have implications for patient selection for ICD therapy.Keywords
This publication has 31 references indexed in Scilit:
- Infarct Tissue Heterogeneity Assessed With Contrast-Enhanced MRI Predicts Spontaneous Ventricular Arrhythmia in Patients With Ischemic Cardiomyopathy and Implantable Cardioverter-DefibrillatorCirculation: Cardiovascular Imaging, 2009
- Extent of Left Ventricular Scar Predicts Outcomes in Ischemic Cardiomyopathy Patients With Significantly Reduced Systolic Function: A Delayed Hyperenhancement Cardiac Magnetic Resonance StudyJACC: Cardiovascular Imaging, 2009
- Comparison of Myocardial Infarct Size Assessed With Contrast-Enhanced Magnetic Resonance Imaging and Left Ventricular Function and Volumes to Predict Mortality in Patients With Healed Myocardial InfarctionThe American Journal of Cardiology, 2007
- Infarct Tissue Heterogeneity by Magnetic Resonance Imaging Identifies Enhanced Cardiac Arrhythmia Susceptibility in Patients With Left Ventricular DysfunctionCirculation, 2007
- “Shades of Gray” in Cardiac Magnetic Resonance Images of Infarcted MyocardiumCirculation, 2006
- Prediction of sudden cardiac death after acute myocardial infarction: role of Holter monitoring in the modern treatment eraEuropean Heart Journal, 2005
- Interpretation of observational studiesHeart, 2004
- OsiriX: An Open-Source Software for Navigating in Multidimensional DICOM ImagesJournal of Digital Imaging, 2004
- Ambulatory sudden cardiac death: Mechanisms of production of fatal arrhythmia on the basis of data from 157 casesAmerican Heart Journal, 1989
- Partial residuals for the proportional hazards regression modelBiometrika, 1982