Arrhythmic risk stratification in patients with left ventricular ring-like scar.

Autor:	Parisi V; Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.; Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy.; European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart-ERN GUARD-Heart., Graziosi M; Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.; European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart-ERN GUARD-Heart., Lopes LR; Barts Heart Centre, St Bartholomew's Hospital, London, UK.; Institute of Cardiovascular Science, University College London, London, UK., De Luca A; Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina and University of Trieste, Trieste, Italy., Pasquale F; Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.; European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart-ERN GUARD-Heart., Tini G; Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, Sapienza University, Rome, Italy., Targetti M; Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy., Cueto MR; Barts Heart Centre, St Bartholomew's Hospital, London, UK.; Heart Failure and Cardiomyopathies Clinic, Germans Trias i Pujol University Hospital, Badalona, Spain., Moura AR; Barts Heart Centre, St Bartholomew's Hospital, London, UK.; Unidade Local de Saúde de Matosinhos, Portugal., Ditaranto R; Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.; Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy.; European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart-ERN GUARD-Heart., Torlasco C; IRCCS, Istituto Auxologico Italiano, Department of Cardiology, Cardiomyopathy Unit, San Luca Hospital, Milan, Italy., Taglieri N; Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.; European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart-ERN GUARD-Heart., Nardi E; Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy., Lovato L; Pediatric and Adult Cardio-Thoracic and Vascular, Onco-Hematologic and Emergency Radiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna., Augusto JB; Institute of Cardiovascular Science, University College London, London, UK.; Cardiology Department, Hospital Prof Doutor Fernando Fonseca, Amadora, Portugal.; Católica Medical School, Universidade Católica Portuguesa, Lisbon, Portugal., Galiè N; Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.; Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy.; European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart-ERN GUARD-Heart., Crotti L; European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart-ERN GUARD-Heart.; IRCCS, Istituto Auxologico Italiano, Department of Cardiology, Cardiomyopathy Unit, San Luca Hospital, Milan, Italy.; Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy., Gasperetti A; Division of Cardiology, School of Medicine, Johns Hopkins University, 600 N. Wolfe St. Blalock 545, Baltimore, MD 21287, USA., Biffi M; Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.; European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart-ERN GUARD-Heart., Autore C; Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, Sapienza University, Rome, Italy., Merlo M; Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina and University of Trieste, Trieste, Italy., Olivotto I; Meyer Children Hospital and Careggi University Hospital, University of Florence, Florence, Italy., Sinagra G; Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina and University of Trieste, Trieste, Italy., Elliott PM; Barts Heart Centre, St Bartholomew's Hospital, London, UK.; Institute of Cardiovascular Science, University College London, London, UK., Biagini E; Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.; European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart-ERN GUARD-Heart.
Jazyk:	angličtina
Zdroj:	European journal of preventive cardiology [Eur J Prev Cardiol] 2024 Nov 01. Date of Electronic Publication: 2024 Nov 01.
DOI:	10.1093/eurjpc/zwae353
Abstrakt:	Aims: Left ventricular (LV) ring-like scar on cardiac magnetic resonance (CMR) has been linked to malignant arrhythmias in patients with non-ischemic cardiomyopathy. This study aimed to perform a comprehensive evaluation of this phenotype and to identify risk factors for life-threatening arrhythmic events (LAEs), a composite of sudden cardiac death (SCD), aborted SCD, and sustained ventricular tachycardia. Methods and Results: One-hundred-fifteen patients (median age 39 [IQR 28-52], 42% females) were identified at 6 referral centres. Inclusion criteria were ring-like LV scar (≥ 3 contiguous segments with subepicardial/midwall late gadolinium enhancement (LGE) in the same slice) and one among: pathogenic/likely pathogenic genetic variant, family history for cardiomyopathy, or arrhythmogenic cardiomyopathy diagnosis. During the study follow-up, survival-free from LAEs was 60% (3.8 events/100 patients/year); at a median follow-up of 4.6 years (IQR 1.7-8.4) it was 84%. On multivariable analysis, anterior Q waves (HR:1.030, 95% CI:1.014-1.046, p < 0.001), QRS width (HR:4.642, 95% CI:1.296-16.628, p=0.018), and LV end-diastolic volume index (LVEDVi) (HR:1.011, 95% CI:1.001-1.021, per mL/m2 increase, p=0.040) were independently associated with LAEs; with good discrimination power (Harrell's C-index=0.796). Three risk categories were identified: normal ECG, abnormal ECG and no LAEs predictive variables, abnormal ECG and ≥ 1 LAEs predictive variables, with a decreasing survival from 100% to 65% and 49%, respectively (Log-rank test = 0.015). Conclusions: In this study, the LV ring-like scar phenotype was associated with a high rate of malignant arrhythmias in presence of anterior Q waves, QRS prolongation, and increased LVEDVi. A normal ECG identified a lower risk subgroup. (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology.)
Databáze:	MEDLINE
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