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Left ventricular scar burden specifies the potential for ventricular arrhythmogenesis: An LGE-CMR Study

Left ventricular scar burden specifies the potential for ventricular arrhythmogenesis: An LGE-CMR Study
Left ventricular scar burden specifies the potential for ventricular arrhythmogenesis: An LGE-CMR Study
INTRODUCTION: The extent of left ventricular (LV) scar, characterized by late gadolinium enhancement cardiac MRI (LGE-CMR), has been shown to predict the occurrence of ventricular arrhythmias in implantable cardioverter defibrillator (ICD) recipients. However, the specificity of LGE-CMR for sudden cardiac death (SCD) versus non-SCD is unclear. The aim of this retrospective, observational study was to evaluate this relationship in a cohort of ICD recipients.

METHODS AND RESULTS: We included consecutive patients who had undergone LGE-CMR before ICD implantation over a 4-year period (2006-2009). Scar (defined as myocardium with a signal intensity ?50% of the maximum in scar tissue) was characterized in terms of percent scar and number of transmural LV scar segments in a 17-segment model. The endpoints were appropriate ICD therapy and all-cause mortality. Sixty-four patients (average age 66 ± 11 years, 51 male, median LVEF 30%) were included. During 42 ± 13 months follow-up, appropriate ICD therapy occurred in 28 patients (44%), and 14 patients (22%) died. Number of transmural scar segments (P = 0.005) and percentage LV scar (P = 0.03) were both significantly associated with appropriate ICD therapy. However, neither number of transmural scar segments (P = 0.32) or percent LV scar (P = 0.59) was significantly associated with all-cause mortality.

CONCLUSION: In this observational study, in medium-term follow-up, the extent of LV scar characterized by LGE-CMR was strongly associated with the occurrence of spontaneous ventricular arrhythmias but not all-cause mortality. We hypothesize that scar quantification by LGE-CMR may be more specific for SCD than non-SCD, and may prove a valuable tool for the selection of patients for ICD therapy.
arrhythmia, coronary artery disease, implantable cardioverter defibrillator, magnetic resonance imaging, mortality, sudden cardiac death
1045-3873
430-436
Scott, Paul A.
5a16b1f4-74d3-473f-9eeb-c2a823d690dc
Rosengarten, James A.
3ccf8397-ca9e-4b04-864f-5c2515db8965
Murday, David C.
83996cf2-0415-4958-912d-9f76600e008b
Peebles, Charles R.
8eb51995-0f07-46f7-9ca2-f97301fefc3d
Harden, Stephen P.
f9e4da31-e002-4e06-9b4e-5c3bec3629c5
Curzen, Nick P.
70f3ea49-51b1-418f-8e56-8210aef1abf4
Morgan, John M.
ac98099e-241d-4551-bc98-709f6dfc8680
Scott, Paul A.
5a16b1f4-74d3-473f-9eeb-c2a823d690dc
Rosengarten, James A.
3ccf8397-ca9e-4b04-864f-5c2515db8965
Murday, David C.
83996cf2-0415-4958-912d-9f76600e008b
Peebles, Charles R.
8eb51995-0f07-46f7-9ca2-f97301fefc3d
Harden, Stephen P.
f9e4da31-e002-4e06-9b4e-5c3bec3629c5
Curzen, Nick P.
70f3ea49-51b1-418f-8e56-8210aef1abf4
Morgan, John M.
ac98099e-241d-4551-bc98-709f6dfc8680

Scott, Paul A., Rosengarten, James A., Murday, David C., Peebles, Charles R., Harden, Stephen P., Curzen, Nick P. and Morgan, John M. (2013) Left ventricular scar burden specifies the potential for ventricular arrhythmogenesis: An LGE-CMR Study. Journal of Cardiovascular Electrophysiology, 24 (4), 430-436. (doi:10.1111/jce.12035). (PMID:23210601)

Record type: Article

Abstract

INTRODUCTION: The extent of left ventricular (LV) scar, characterized by late gadolinium enhancement cardiac MRI (LGE-CMR), has been shown to predict the occurrence of ventricular arrhythmias in implantable cardioverter defibrillator (ICD) recipients. However, the specificity of LGE-CMR for sudden cardiac death (SCD) versus non-SCD is unclear. The aim of this retrospective, observational study was to evaluate this relationship in a cohort of ICD recipients.

METHODS AND RESULTS: We included consecutive patients who had undergone LGE-CMR before ICD implantation over a 4-year period (2006-2009). Scar (defined as myocardium with a signal intensity ?50% of the maximum in scar tissue) was characterized in terms of percent scar and number of transmural LV scar segments in a 17-segment model. The endpoints were appropriate ICD therapy and all-cause mortality. Sixty-four patients (average age 66 ± 11 years, 51 male, median LVEF 30%) were included. During 42 ± 13 months follow-up, appropriate ICD therapy occurred in 28 patients (44%), and 14 patients (22%) died. Number of transmural scar segments (P = 0.005) and percentage LV scar (P = 0.03) were both significantly associated with appropriate ICD therapy. However, neither number of transmural scar segments (P = 0.32) or percent LV scar (P = 0.59) was significantly associated with all-cause mortality.

CONCLUSION: In this observational study, in medium-term follow-up, the extent of LV scar characterized by LGE-CMR was strongly associated with the occurrence of spontaneous ventricular arrhythmias but not all-cause mortality. We hypothesize that scar quantification by LGE-CMR may be more specific for SCD than non-SCD, and may prove a valuable tool for the selection of patients for ICD therapy.

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More information

e-pub ahead of print date: 4 December 2012
Published date: April 2013
Keywords: arrhythmia, coronary artery disease, implantable cardioverter defibrillator, magnetic resonance imaging, mortality, sudden cardiac death
Organisations: Human Development & Health

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Local EPrints ID: 355252
URI: http://eprints.soton.ac.uk/id/eprint/355252
ISSN: 1045-3873
PURE UUID: 7460a5fe-7a54-46c5-9d53-ae9c0dd0b06c
ORCID for Nick P. Curzen: ORCID iD orcid.org/0000-0001-9651-7829

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Date deposited: 16 Aug 2013 09:25
Last modified: 09 Jan 2022 03:19

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Contributors

Author: Paul A. Scott
Author: James A. Rosengarten
Author: David C. Murday
Author: Charles R. Peebles
Author: Stephen P. Harden
Author: Nick P. Curzen ORCID iD
Author: John M. Morgan

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