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
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
BACKGROUND:
Characterization of sudden cardiac death (SCD) risk remains a challenge in the application of implantable cardioverter-defibrillator (ICD) therapy. Late gadolinium enhancement cardiac MRI (LGE-CMR) can accurately identify myocardial scar. We performed a retrospective, single-center observational study to evaluate the association between the extent and distribution of left ventricular scar, quantified using LGE-CMR, and the burden of ventricular arrhythmias in patients with coronary artery disease and ICDs.
METHODS AND RESULTS:
All patients included (2006 to 2009) had undergone LGE-CMR before ICD implantation. Scar (defined as myocardium with a signal intensity ?50% of the maximum in scar tissue) was characterized in terms of percent scar, scar surface area, and number of transmural left ventricular scar segments. The end point was appropriate ICD therapy. Sixty-four patients (mean age, 66±11 years; male sex, 51) were included. During 19±10 months follow-up, appropriate ICD therapy occurred in 19 (30%) patients. In Cox regression analyses, both percent scar (hazard ratio per 10%, 1.75; 95% CI, 1.09 to 2.81; P=0.02) and number of transmural scar segments (hazard ratio per segment, 1.40; 95% CI, 1.15 to 1.70; P=0.001) were significantly associated with the occurrence of appropriate ICD therapy.
CONCLUSIONS:
In this pilot study, the extent of myocardial scar characterized by LGE-CMR was significantly associated with the occurrence of spontaneous ventricular arrhythmias. We hypothesize that scar quantification by LGE-CMR may prove a valuable risk stratification tool for the occurrence of ventricular arrhythmias, which may have implications for patient selection for ICD therapy.
324-330
Scott, Paul A.
5a16b1f4-74d3-473f-9eeb-c2a823d690dc
Morgan, John M.
ac98099e-241d-4551-bc98-709f6dfc8680
Carroll, Nicola
0971a6e7-1209-49e3-b6d2-70e956425927
Murday, David C.
83996cf2-0415-4958-912d-9f76600e008b
Roberts, Paul R.
193431e8-f9d5-48d6-8f62-ed9052b2571d
Peebles, Charles R.
1a53643a-f62c-41fa-b706-c3eb282a5fe0
Harden, Stephen P.
f9e4da31-e002-4e06-9b4e-5c3bec3629c5
Curzen, Nick P.
70f3ea49-51b1-418f-8e56-8210aef1abf4
June 2011
Scott, Paul A.
5a16b1f4-74d3-473f-9eeb-c2a823d690dc
Morgan, John M.
ac98099e-241d-4551-bc98-709f6dfc8680
Carroll, Nicola
0971a6e7-1209-49e3-b6d2-70e956425927
Murday, David C.
83996cf2-0415-4958-912d-9f76600e008b
Roberts, Paul R.
193431e8-f9d5-48d6-8f62-ed9052b2571d
Peebles, Charles R.
1a53643a-f62c-41fa-b706-c3eb282a5fe0
Harden, Stephen P.
f9e4da31-e002-4e06-9b4e-5c3bec3629c5
Curzen, Nick P.
70f3ea49-51b1-418f-8e56-8210aef1abf4
Scott, Paul A., Morgan, John M., Carroll, Nicola, Murday, David C., Roberts, Paul R., Peebles, Charles R., Harden, Stephen P. and Curzen, Nick P.
(2011)
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.
Circulation: Arrhythmia and Electrophysiology, 4 (3), .
(doi:10.1161/?CIRCEP.110.959544).
Abstract
BACKGROUND:
Characterization of sudden cardiac death (SCD) risk remains a challenge in the application of implantable cardioverter-defibrillator (ICD) therapy. Late gadolinium enhancement cardiac MRI (LGE-CMR) can accurately identify myocardial scar. We performed a retrospective, single-center observational study to evaluate the association between the extent and distribution of left ventricular scar, quantified using LGE-CMR, and the burden of ventricular arrhythmias in patients with coronary artery disease and ICDs.
METHODS AND RESULTS:
All patients included (2006 to 2009) had undergone LGE-CMR before ICD implantation. Scar (defined as myocardium with a signal intensity ?50% of the maximum in scar tissue) was characterized in terms of percent scar, scar surface area, and number of transmural left ventricular scar segments. The end point was appropriate ICD therapy. Sixty-four patients (mean age, 66±11 years; male sex, 51) were included. During 19±10 months follow-up, appropriate ICD therapy occurred in 19 (30%) patients. In Cox regression analyses, both percent scar (hazard ratio per 10%, 1.75; 95% CI, 1.09 to 2.81; P=0.02) and number of transmural scar segments (hazard ratio per segment, 1.40; 95% CI, 1.15 to 1.70; P=0.001) were significantly associated with the occurrence of appropriate ICD therapy.
CONCLUSIONS:
In this pilot study, the extent of myocardial scar characterized by LGE-CMR was significantly associated with the occurrence of spontaneous ventricular arrhythmias. We hypothesize that scar quantification by LGE-CMR may prove a valuable risk stratification tool for the occurrence of ventricular arrhythmias, which may have implications for patient selection for ICD therapy.
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e-pub ahead of print date: 14 April 2011
Published date: June 2011
Identifiers
Local EPrints ID: 183253
URI: http://eprints.soton.ac.uk/id/eprint/183253
ISSN: 1941-3149
PURE UUID: 6300c441-a344-4fc7-b6c8-8d1433ae7092
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Date deposited: 03 May 2011 09:01
Last modified: 15 Mar 2024 03:23
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Contributors
Author:
Paul A. Scott
Author:
John M. Morgan
Author:
Nicola Carroll
Author:
David C. Murday
Author:
Paul R. Roberts
Author:
Charles R. Peebles
Author:
Stephen P. Harden
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