Myocardial Fibrosis Assessment by LGE Is a Powerful Predictor of Ventricular Tachyarrhythmias in Ischemic and Nonischemic LV Dysfunction

Disertori, Marcello; Rigoni, Marta; Pace, Nicola; Casolo, Giancarlo; Masè, Michela; Gonzini, Lucio; Lucci, Donata; Nollo, Giandomenico; Ravelli, Flavia

doi:10.1016/j.jcmg.2016.01.033

Cited by 266 publications

(178 citation statements)

References 38 publications

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“…More interestingly, there is growing evidence that myocardial fibrosis is an independent predictor of mortality in patients with AS after AVR, even when detected in the asymptomatic phase of the disease 5 34–36. There is still no clear pathophysiological link between myocardial fibrosis and increased mortality; however, worse diastolic dysfunction and associated heart failure, as well as arrhythmogenesis are likely culprits 37. In a recent study, Chin et al used CMR to classify patients in three groups of myocardial fibrosis severity regardless of AS severity (figure 3).…”

Section: Impact Of Diastolic Dysfunction On Outcomes After Avrmentioning

confidence: 99%

The role and clinical implications of diastolic dysfunction in aortic stenosis

Kampaktsis

Kokkinidis

Wong

et al. 2017

Heart

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Diastolic dysfunction in aortic stenosis results primarily from left ventricular hypertrophy and myocardial fibrosis due to chronically elevated left ventricular systolic pressure. Currently, diastolic dysfunction does not have an explicit clinical role in management of patients with aortic stenosis. Studies have shown that improvement in diastolic dysfunction follows left ventricular remodelling after aortic valve replacement and that it occurs gradually or incompletely. Retrospective studies suggest that advanced grades of diastolic dysfunction at baseline are associated with increased mortality and adverse events even after aortic valve replacement. Recent studies have also associated myocardial fibrosis, a hallmark of diastolic dysfunction, with worse outcomes. In addition, these results were independent of the degree of aortic stenosis or valve replacement. Indirect evidence of the role of diastolic dysfunction in aortic stenosis also comes from paradoxical low-flow, low-gradient aortic stenosis, where disproportionate left ventricular hypertrophy leads to underfilling of the left ventricle, low-flow state and is associated with worse prognosis. Lastly, a limited number of studies suggest that worse diastolic dysfunction at baseline is detrimental in patients who develop aortic regurgitation after transcatheteraortic valve replacement, due to superimposition of volume overload on a stiff left ventricle. Current major limitations in our understanding of the prognostic role of diastolic dysfunction are the lack of universally accepted classification schemes, its dependence on dynamic loading conditions and the lack of larger prospective studies.

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Section: Impact Of Diastolic Dysfunction On Outcomes After Avrmentioning

confidence: 99%

The role and clinical implications of diastolic dysfunction in aortic stenosis

Kampaktsis

Kokkinidis

Wong

et al. 2017

Heart

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“…Complementarily to HRT, thanks to its high sensitivity and low negative LR, late gadolinium enhancement imaging may help to identify among patients with EF ≤30% a lower-risk group unlikely to benefit from ICD. 45 …”

Section: Downloaded From Hrt As a Predictor Of Sudden Cardiac Deathmentioning

confidence: 99%

Heart Rate Turbulence Is a Powerful Predictor of Cardiac Death and Ventricular Arrhythmias in Postmyocardial Infarction and Heart Failure Patients

Disertori

Masè

Rigoni

et al. 2016

Circ: Arrhythmia and Electrophysiology

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Background-Heart rate turbulence (HRT) has been proposed as a candidate marker of altered autonomic tone, and some studies showed its prognostic value for both cardiac death (CD) and sudden death. Nevertheless, HRT is not currently used in the clinical practice. Methods and Results-We performed a systematic review and meta-analysis of the predictive value of HRT for the end points of total mortality, CD, and fatal and nonfatal ventricular arrhythmias in postacute myocardial infarction and heart failure patients. MEDLINE and The Cochrane Library databases were systematically searched to identify studies, which analyzed the predictive value of abnormal HRT for the defined end points. Twenty studies (25 cohorts: 12 832 patients) were identified by the systematic review, and 15 studies (20 cohorts: 11 499 patients) were included in the meta-analyses. Abnormal HRT was a predictive marker for all the end points in heart failure patients and more markedly in postacute myocardial infarction patients, where 9 out of the 10 cohorts had an ejection fraction >30%. In postacute myocardial infarction patients, HRT had pooled risk ratios of 3.53 (95% confidence interval [CI], 2.54-4.90), 4.82 (95% CI, 3.12-7.45), and 4.48 (95% CI, 3.04-6.60), and positive likelihood ratios of 3.5 (95% CI, 2.6-4.8), 4.1 (95% CI, 3.0-5.7), and 2.7 (95% CI, 2.2-3.3) for total mortality, CD, and arrhythmic events, respectively. The combination of abnormal HRT and T-wave alternans (5 cohorts: 1516 patients) increased the predictive power for CD and arrhythmic events. Conclusions-HRT is a powerful predictor of both CD and arrhythmic events, particularly in postacute myocardial infarction patients with ejection fraction >30%. HRT power increases in combination with T-wave alternans analysis.(Circ Arrhythm Electrophysiol. 2016;9:e004610.

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“…Consequently, elegant computational approaches have been developed to integrate electroanatomic data with microstructural atlases of the heart 32. In a clinical setting, the incorporation of LGE into risk models for sudden cardiac death may improve their accuracy by providing an assessment of the arrhythmic substrate 42, 43. Tractography, in contrast, may enable more direct measurement of alterations in myofiber architecture, which has the potential to better define the substrate for reentrant arrhythmias.…”

Section: Discussionmentioning

confidence: 99%

Myocardial Scar Delineation Using Diffusion Tensor Magnetic Resonance Tractography

Mekkaoui

Jackowski

Kostis

et al. 2018

JAHA

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BackgroundLate gadolinium enhancement (LGE) is the current standard for myocardial scar delineation. In this study, we introduce the tractographic propagation angle (PA), a metric of myofiber curvature (degrees/unit distance) derived from diffusion tensor imaging (DTI), and compare its use to LGE and invasive scar assessment by endocardial voltage mapping.Methods and Results DTI was performed on 7 healthy human volunteers, 5 patients with myocardial infarction, 6 normal mice, and 7 mice with myocardial infarction. LGE to delineate the infarct and border zones was performed with a 2‐dimensional inversion recovery gradient‐echo sequence. Ex vivo DTI was performed on 5 normal human and 5 normal sheep hearts. Endocardial electroanatomic mapping and subsequent ex vivo DTI was performed on 5 infarcted sheep hearts. PA in the normal human hearts varied smoothly and was generally <4. The mean PA in the infarct zone was significantly elevated (10.34±1.02 versus 4.05±0.45, P<0.05). Regions with a PA ≤4 consistently had a bipolar voltage ≥1.5 mV, whereas those with PA values between 4 and 10 had voltages between 0.5 and 1.5 mV. A PA threshold >4 was the most accurate DTI‐derived measure of infarct size and demonstrated the greatest correlation with LGE (r=0.95).ConclusionsWe found a strong correlation between infarct size by PA and LGE in both mice and humans. There was also an inverse relationship between PA values and endocardial voltage. The use of PA may enable myocardial scar delineation and characterization of arrhythmogenic substrate without the need for exogenous contrast agents.

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Myocardial Fibrosis Assessment by LGE Is a Powerful Predictor of Ventricular Tachyarrhythmias in Ischemic and Nonischemic LV Dysfunction

Cited by 266 publications

References 38 publications

The role and clinical implications of diastolic dysfunction in aortic stenosis

The role and clinical implications of diastolic dysfunction in aortic stenosis

Heart Rate Turbulence Is a Powerful Predictor of Cardiac Death and Ventricular Arrhythmias in Postmyocardial Infarction and Heart Failure Patients

Myocardial Scar Delineation Using Diffusion Tensor Magnetic Resonance Tractography

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