Infarct Tissue Heterogeneity Assessed With Contrast-Enhanced MRI Predicts Spontaneous Ventricular Arrhythmia in Patients With Ischemic Cardiomyopathy and Implantable Cardioverter-Defibrillator

Abstract

Background-The relation between infarct tissue heterogeneity on contrast-enhanced MRI and the occurrence of spontaneous ventricular arrhythmia (or sudden cardiac death) is unknown. Therefore, the study purpose was to evaluate the predictive value of infarct tissue heterogeneity assessed with contrast-enhanced MRI on the occurrence of spontaneous ventricular arrhythmia with subsequent implantable cardioverter-defibrillator (ICD) therapy (as surrogate of sudden cardiac death) in patients with previous myocardial infarction.

Relationship Between Infarct Tissue Characteristics and Left Ventricular Remodeling in Patients With Versus Without Early Revascularization for Acute Myocardial Infarction as Assessed With Contrast-Enhanced Cardiovascular Magnetic Resonance Imaging

“…There is increasing interest in quantification of this peri-infarct zone because (mechanical) characteristics of this area may serve as a substrate for lifethreatening ventricular arrhythmia. 9,21,22,27) According to Yan, et al identification of a distinct infarct core and border zone may also provide prognostic insights into post-MI remodeling. 9) However, most previous CE-CMR studies that investigated the relationship between infarct size and cardiac remodeling did not measure the size of the peri-infarct zone.…”

“…Several center-dependent formulas have been used and described, which can be used to analyze infarct tissue characteristics including the heterogeneous zone, while there is currently no consensus on a definite gold standard. We used a formula in which infarct tissue characteristics are defined based on the maximum signal intensity of the infarct area (in accordance with Roes, et al and Schmidt, et al), 21,22) whereas others use a formula in which infarct tissue characteristics are defined as having a signal intensity > 2 SD (up to > 6 SD) above the signal intensity of a normal area of interest (eg, Bello, et al).…”

“…LV REMODELING AND EARLY REVASCULARIZATION tensity ≥ 35% of the maximal signal intensity and < 50% of maximal signal intensity. 21) Total scar was defined as the sum of infarct core plus heterogeneous zone ( Figure 1). By the use of planimetry, the extent of CE was first determined on contiguous short-axis images, then summed up to a volume, and finally expressed as a percentage of the total myocardial volume.…”

“…3,6,8,9,[17][18][19] Cardiovascular magnetic resonance (CMR) imaging in combination with the contrast enhancement (CE) technique allows accurate assessment of LV geometry and function as well as tissue characteristics such as size, heterogeneity, and transmurality of the myocardial scar. [20][21][22] In the present study, we investigated the relation between infarct tissue characteristics and LV remodeling in patients with versus without successful early revascularization in a population of consecutive patients who underwent CE-CMR examination.…”

Renal Denervation in CKD Hypertensive Patients: Would it be Possible to Prevent the Development of Risk Factors Responsible for Sudden Cardiac Death in this Population?

“…9,10 Any LVH and cardiac fibrosis has been linked to increased risk of sustained ventricular arrhythmias and predisposition to sudden cardiac death (SCD). [11][12][13][14][15] In hypertensive patients with elevated E/e′ ratio (non-invasive method to allow early assessment of left ventricular filling pressure, estimated by tissue Doppler) the annual mortality rate is 10% and the ratio is considered to be a prognostic factor for the development of cardiovascular disease (CVD). 16 Diastolic heart failure is an important factor that increases mortality related to the cardiovascular system in patients with CKD whose extent of kidney function deterioration differs.…”