Cardiovascular magnetic resonance determinants of ventricular arrhythmic events after myocardial infarction

Abstract

Aims To non-invasively characterize, by means of late gadolinium enhancement cardiac magnetic resonance (LGE-CMR), scar differences, and potential variables associated with ventricular tachycardia (VT) occurrence in chronic post-myocardial infarction (MI) patients. Methods and results A case–control study was designed through retrospective LGE-CMR data analysis of chronic post-MI patients (i) consecutively referred for VT substrate ablation after a first VT episode (n = 66) and (ii) from a control group (n = 84) with no arrhythmia evidence. The myocardium was characterized differentiating core, border zone (BZ), and BZ channels (BZCs) using the ADAS 3D post-processing imaging platform. Clinical and scar characteristics, including a novel parameter, the BZC mass, were compared between both groups. One hundred and fifty post-MI patients were included. Four multivariable Cox proportional hazards regression models were created for total scar mass, BZ mass, core mass, and BZC mass, adjusting them by age, sex, and left ventricular ejection fraction (LVEF). A cut-off of 5.15 g of BZC mass identified the cases with 92.4% sensitivity and 86.9% specificity [area under the ROC curve (AUC) 0.93 (0.89–0.97); P < 0.001], with a significant increase in the AUC compared to other scar parameters (P < 0.001 for all pairwise comparisons). Adding BZC mass to LVEF allowed to reclassify 33.3% of the cases and 39.3% of the controls [net reclassification improvement = 0.73 (0.71–0.74)]. Conclusions The mass of BZC is the strongest independent variable associated with the occurrence of sustained monomorphic ventricular tachycardia in post-MI patients after adjustment for age, sex, and LVEF. Border zone channel mass measurement could permit a more accurate VT risk stratification than LVEF in chronic post-MI patients.

Scar border zone mass and presence of border zone channels assessed with cardiac magnetic resonance imaging are associated with ventricular arrhythmia in patients with ST-segment elevation myocardial infarction

“…Acosta et al 24 found the presence, extension, heterogeneity, and qualitative distribution of BZ tissue of myocardial scar to independently predict appropriate ICD therapies and SCD. Similarly, Jáuregui et al 25 demonstrated that the BZ channels mass was the strongest independent variable associated with the occurrence of VT in post-MI patients. Results are comparable to the current.…”

“…However, to our knowledge, this has not been demonstrated in earlier studies using the same method as ours. 5 , 14 , 15 , 21 , 24 , 25 Also, our study population was small and might not reach statistical significance due to lack of power.…”

Development and Validation of a Cardiovascular Disease Risk Prediction Model for Patients with Non-Dialysis-Dependent Chronic Kidney Diseases Based on the Nomogram

“…For instance, patients who have suffered a myocardial infarction are more likely to develop chronic ischemic heart failure [21], which increases the chance of CV death. In addition, due to myocardial ischemia and vagal stimulation, arrhythmias such as sinus bradycardia and atrioventricular block are prone to occur in the early stages of myocardial infarction [22,23]. Some common risk factors, such as blood glucose, blood lipids, and blood pressure, can also cause new CV events in individuals who have already had a heart attack or stroke [24,25].…”

Twenty-five years of research in cardiac imaging in electrophysiology procedures for atrial and ventricular arrhythmias

“…The presence of channels and the border zone channel mass has been shown to be the strongest determinant of VA occurrence after a myocardial infarction after adjustment for other variables related with the LV function and scar. 114 These channels also distinguish patients at higher risk of VTs during follow-up in other clinical situations like cardiac resynchronization therapy and even in non-ischaemic cardiomyopathy. 109 , 111 , 115 …”