The Extent of Left Ventricular Scar Quantified by Late Gadolinium Enhancement MRI Is Associated With Spontaneous Ventricular Arrhythmias in Patients With Coronary Artery Disease and Implantable Cardioverter-Defibrillators

Scott, Paul A.; Morgan, John M.; Carroll, Nicola; Murday, David C.; Roberts, Paul R.; Peebles, Charles; Harden, S.; Curzen, Nick

doi:10.1161/circep.110.959544

Cited by 120 publications

(74 citation statements)

References 41 publications

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“…Patients with a positive EPS, however, displayed a higher number of transmural scar segments with >75% transmurality. This resembles the findings in the study performed by Scott et al, 32 which demonstrated that the number of myocardial segments with full-thickness (>75% transmurality) scar was the most important risk factor for appropriate ICD therapy. However, in the current study, scar transmurality was not associated with VA inducibility in univariate analysis.…”

Section: Discussionsupporting

confidence: 88%

“…More importantly, the role of scar burden in risk stratification for spontaneous VA events was demonstrated in ischemic and nonischemic cardiomyopathy. [26][27][28][29][30]32 In the present study, the difference in scar size between EPS negative and positive patients did not reach statistical significance. This might be because of the smaller sample size included in this study as compared with the abovementioned larger studies.…”

Section: Discussioncontrasting

confidence: 79%

“…24 Currently, much effort is put into the search for enhanced risk stratification markers, which assess the pathophysiological substrate related to electric instability. 25 Among parameters such as scar burden 16,[26][27][28][29][30][31][32] and sympathetic innervation defects, 33 ischemia might play an important role. Myocardial perfusion abnormalities resulting in ischemia are well known to modulate automaticity, excitability, and refractoriness.…”

Section: Discussionmentioning

confidence: 99%

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Impaired Hyperemic Myocardial Blood Flow Is Associated With Inducibility of Ventricular Arrhythmia in Ischemic Cardiomyopathy

Rijnierse

Haan

Harms

et al. 2014

Circ: Cardiovascular Imaging

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O]H 2 O positron-emission tomography was performed to quantify resting MBF, hyperemic MBF, and coronary flow reserve. Left ventricular dimensions, function, and scar burden were assessed with cardiovascular magnetic resonance imaging. An electrophysiological study was performed to test VA inducibility. Positive electrophysiological study patients (n=12) showed reduced hyperemic MBF (1.25±0.30 versus 1.66±0.38 mL•min ; P<0.01) and coronary flow reserve (1.59±0.49 versus 2.12±0.48; P<0.01) compared with electrophysiological study negative patients (n=18). In electrophysiological study positive patients, the number of scar segments >75% transmurality was higher (P<0.05), although scar size and border zone did not differ. Receiver-operating characteristic curve analysis indicated that impaired hyperemic MBF (area under the curve, 0.84; 95% confidence intervals [0.69-0.99 arrhythmias are an important and common cause of death in these classifications of cardiomyopathy, suggesting that quantitative assessment of MBF could be used not merely for risk stratification but specifically to identify patients prone to SCD. 14 The link between the occurrence of VA and impaired myocardial perfusion, however, remains to be elucidated.The aim of this pilot study was to assess whether hyperemic MBF and CFR as assessed with [15 O]H 2 O PET are associated with VA inducibility during an electrophysiological study (EPS) in patients with ischemic cardiomyopathy. Furthermore, the role of alternative risk factors such as LVEF, scar size, transmurality, and border zone as assessed with cardiovascular magnetic resonance (CMR) imaging was evaluated. Methods Study PopulationPatients with ischemic cardiomyopathy and LVEF ≤35%, who were referred for ICD implantation for primary prevention of SCD based on current guidelines, 4 were prospectively included. Exclusion criteria were a cardiac rhythm other than sinus rhythm and a previous history of sustained VA. During the study period, 581 ICD devices were implanted, of which 316 devices were combined with resynchronization therapy or implanted for secondary prevention indication. Of the remaining 265 patients, 109 had nonischemic cardiomyopathy, and another 19 patients did not have sinus rhythm. Of the remaining 137 eligible patients, 107 patients could not be included because of refusal of participation, logistical issues, or other contraindications for PET, CMR, or EPS. A total of 30 patients were included in the described study. None of the patients displayed residual ischemia at noninvasive testing amendable to revascularization before referral for ICD implantation. All patients underwent CMR, PET, and EPS for research purposes after inclusion in this study. The study was approved by the Ethics Committee of the VU University Medical Center, in accordance with the Declaration of Helsinki, and written informed consent was obtained from all patients. CMR Image AcquisitionCMR studies were performed on a clinical 1.5-T MRI scanner (Magnetom Avanto; Siemens, Erlangen, Germany) using a dedicated pha...

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Section: Discussionsupporting

confidence: 88%

Section: Discussioncontrasting

confidence: 79%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Impaired Hyperemic Myocardial Blood Flow Is Associated With Inducibility of Ventricular Arrhythmia in Ischemic Cardiomyopathy

Rijnierse

Haan

Harms

et al. 2014

Circ: Cardiovascular Imaging

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show abstract

“…In Figure 1 cardiac MRI performed on a patient 18 years of age with a 24-month history of SSc who was excluded from HSCT despite normal right heart catheterization shows extensive intramyocardial fibrosis that increases risk of arrhythmias 21 . Figure 2 shows the cardiac MRI of a patient excluded from HSCT despite normal PASP because of a failing right heart as demonstrated by intraventricular diastolic flattening (D-sign) and elevated PVR.…”

Section: Rheumatologymentioning

confidence: 99%

Hematopoietic Stem Cell Transplantation for Systemic Sclerosis: If You Are Confused, Remember: “It Is a Matter of the Heart”

Burt¹,

Shah²,

Gheorghiade³

et al. 2012

J Rheumatol

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“…The scars are evident on MRI as areas of late gadolinium enhancement. 13,14 Scars are a durable arrhythmia substrate, such that the likelihood of a VT recurrence following the initial episode of scar-related VT can exceed 20% per year. 15,16 ICDs, however, often can terminate monomorphic VTs by applying a burst of pacing (antitachycardia pacing,) that is painless.…”

Section: Monomorphic Vt Versus Polymorphic Vt/vfmentioning

confidence: 99%

Ventricular Arrhythmias in Patients With Implanted Defibrillators

Stevenson

John

2011

Circulation

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The Extent of Left Ventricular Scar Quantified by Late Gadolinium Enhancement MRI Is Associated With Spontaneous Ventricular Arrhythmias in Patients With Coronary Artery Disease and Implantable Cardioverter-Defibrillators

Abstract: Background-Characterization

Cited by 120 publications

References 41 publications

Impaired Hyperemic Myocardial Blood Flow Is Associated With Inducibility of Ventricular Arrhythmia in Ischemic Cardiomyopathy

Impaired Hyperemic Myocardial Blood Flow Is Associated With Inducibility of Ventricular Arrhythmia in Ischemic Cardiomyopathy

Hematopoietic Stem Cell Transplantation for Systemic Sclerosis: If You Are Confused, Remember: “It Is a Matter of the Heart”

Ventricular Arrhythmias in Patients With Implanted Defibrillators

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