Magnetic resonance estimates of the extent and heterogeneity of scar tissue in ICD patients with ischemic cardiomyopathy predict ventricular arrhythmia

Autor: Mohammed Shurrab, E. Kadmon, Graham A. Wright, Alexander Dick, Donsheng Gao, Avishag Laish Farkash, Gideon A Paul, David Newman, Darren Kagal, Tawfiq Zeidan-Shwiri, Ilan Lashevsky, Yuesong Yang, Eugene Crystal
Rok vydání: 2015
Předmět:
Male
Canada
medicine.medical_specialty
medicine.medical_treatment
Myocardial Infarction
Magnetic Resonance Imaging
Cine
Ventricular tachycardia
Risk Assessment
Article
Cicatrix
Predictive Value of Tests
Cardiac magnetic resonance imaging
Physiology (medical)
Internal medicine
Image Processing
Computer-Assisted
medicine
Humans
Prospective Studies
cardiovascular diseases
Myocardial infarction
Aged
Ischemic cardiomyopathy
medicine.diagnostic_test
business.industry
Myocardium
Magnetic resonance imaging
Sudden cardiac arrest
Middle Aged
Implantable cardioverter-defibrillator
medicine.disease
Defibrillators
Implantable
Death
Sudden
Cardiac
Ventricular fibrillation
Tachycardia
Ventricular
cardiovascular system
Cardiology
Female
medicine.symptom
Cardiomyopathies
Cardiology and Cardiovascular Medicine
business
Follow-Up Studies
Zdroj: Heart Rhythm. 12:802-808
ISSN: 1547-5271
DOI: 10.1016/j.hrthm.2015.01.007
Popis: Background The majority of patients receiving implantable cardioverter-defibrillator (ICD) implantation under current guidelines never develop sustained ventricular arrhythmia; therefore, better markers of risk for sustained ventricular tachycardia and/or ventricular fibrillation are needed. Objective The purpose of this study was to identify cardiac magnetic resonance arrhythmic risk predictors of ischemic cardiomyopathy before ICD implantation. Methods Forty-three subjects (mean age, 64.5 ± 11.9 years) with previous myocardial infarction who were referred for ICD implantation were evaluated by cardiac magnetic resonance imaging (MRI). The MRI protocol included left ventricular functional parameter assessment using steady-state free precession and late gadolinium enhancement MRI using inversion recovery fast gradient echo. Left ventricular functional parameters were measured using cardiac magnetic resonance software. Subjects were followed up for 6–46 months, and the events of appropriate ICD treatments (shocks and antitachycardia pacing) were recorded. Results Twenty-eight patients experienced 46 spontaneous episodes during a median follow-up duration of 30 months. The total myocardial infarct (MI) size (18.05 ± 11.44 g vs 38.83 ± 19.87 g; P = .0006), MI core (11.63 ± 7.14 g vs 24.12 ± 12.73 g; P = .0002), and infarct gray zone (6.43 ± 4.64 g vs 14.71 ± 7.65 g; P = .0004) were significantly larger in subjects who received appropriate ICD therapy than in those who did not experience an episode of ventricular tachycardia and/or ventricular fibrillation. Multivariate regression analyses for the infarct gray zone and MI core adjusted for New York Heart Association class, diabetes, and etiology (primary or secondary prevention) revealed that the gray zone and MI core were predictors of appropriate ICD therapies ( P = .0018 and P = .007, respectively). Conclusion The extent of MI scar may predict which patients would benefit most from ICD implantation.
Databáze: OpenAIRE
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