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The relationship between left ventricular scar and ventricular repolarization in patients with coronary artery disease: insights from late gadolinium enhancement magnetic resonance imaging

The relationship between left ventricular scar and ventricular repolarization in patients with coronary artery disease: insights from late gadolinium enhancement magnetic resonance imaging
The relationship between left ventricular scar and ventricular repolarization in patients with coronary artery disease: insights from late gadolinium enhancement magnetic resonance imaging
AIMS: The markers of ventricular repolarization corrected QT interval (QTc), QT dispersion (QTD) and Tpeak-to-Tend interval (Tpeak-end) have shown an association with sudden cardiac death (SCD) in the general population. However, their mechanistic relationship with SCD is unclear. The study aim was to evaluate the relationship between QTc, QTD, and Tpeak-end, and the extent and distribution of left ventricular (LV) scar in patients with coronary artery disease at high SCD risk.

METHODS AND RESULTS: We included 64 consecutive implantable cardioverter defibrillator (ICD) recipients (66 ± 11 years, 80% male, median left ventricular ejection fraction 30%) who had undergone late gadolinium enhancement cardiac magnetic resonance (CMR) imaging prior to device implantation over 4 years. Scar was quantified using the CMR images and characterized in terms of percent LV scar and number of LV segments with subendocardial/transmural scar. Repolarization parameters were measured on an electrocardiogram performed prior to ICD implantation. After adjustment for potential confounders there was a strong association between the number of limited subendocardial (1-25% transmurality) scar segments and QTc (P = 0.003), QTD (P = 0.002), and Tpeak-end (P = 0.008). However, there was no association between the repolarization parameters and percent LV scar or the amount of transmural scar. During a mean follow-up of 19 ± 10 months 19 (30%) patients received appropriate ICD therapy, but none of the repolarization parameters were associated with its occurrence.

CONCLUSION: In this pilot study there was a strong association between limited subendocardial LV scar and prolonged QTc, QTD, and Tpeak-end. However, there was no association between any of these repolarization markers and the delivery of appropriate ICD therapy.

arrhythmia, coronary artery disease, electrocardiogram, implantable cardioverter defibrillator, magnetic resonance imaging, sudden death
1099-5129
899-906
Scott, Paul A.
5a16b1f4-74d3-473f-9eeb-c2a823d690dc
Rosengarten, James
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Shahed, Anwar
94ab60f0-ffea-4fcf-9afe-5bc229078fac
Yue, Arthur M.
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Murday, David C.
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Roberts, Paul R.
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Peebles, Charles
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Harden, Stephen P.
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Curzen, N.
70f3ea49-51b1-418f-8e56-8210aef1abf4
Morgan, John M.
ac98099e-241d-4551-bc98-709f6dfc8680
Scott, Paul A.
5a16b1f4-74d3-473f-9eeb-c2a823d690dc
Rosengarten, James
3ccf8397-ca9e-4b04-864f-5c2515db8965
Shahed, Anwar
94ab60f0-ffea-4fcf-9afe-5bc229078fac
Yue, Arthur M.
4040f8ec-0252-49e0-b838-58f37956acd2
Murday, David C.
94f67327-c24a-4533-8bc3-624688cb81f1
Roberts, Paul R.
193431e8-f9d5-48d6-8f62-ed9052b2571d
Peebles, Charles
8eb51995-0f07-46f7-9ca2-f97301fefc3d
Harden, Stephen P.
a7e9f3e7-054d-4297-a5b2-06dc16b5ab18
Curzen, N.
70f3ea49-51b1-418f-8e56-8210aef1abf4
Morgan, John M.
ac98099e-241d-4551-bc98-709f6dfc8680

Scott, Paul A., Rosengarten, James, Shahed, Anwar, Yue, Arthur M., Murday, David C., Roberts, Paul R., Peebles, Charles, Harden, Stephen P., Curzen, N. and Morgan, John M. (2013) The relationship between left ventricular scar and ventricular repolarization in patients with coronary artery disease: insights from late gadolinium enhancement magnetic resonance imaging. Europace, 15 (6), 899-906. (doi:10.1093/europace/eus362). (PMID:23143860)

Record type: Article

Abstract

AIMS: The markers of ventricular repolarization corrected QT interval (QTc), QT dispersion (QTD) and Tpeak-to-Tend interval (Tpeak-end) have shown an association with sudden cardiac death (SCD) in the general population. However, their mechanistic relationship with SCD is unclear. The study aim was to evaluate the relationship between QTc, QTD, and Tpeak-end, and the extent and distribution of left ventricular (LV) scar in patients with coronary artery disease at high SCD risk.

METHODS AND RESULTS: We included 64 consecutive implantable cardioverter defibrillator (ICD) recipients (66 ± 11 years, 80% male, median left ventricular ejection fraction 30%) who had undergone late gadolinium enhancement cardiac magnetic resonance (CMR) imaging prior to device implantation over 4 years. Scar was quantified using the CMR images and characterized in terms of percent LV scar and number of LV segments with subendocardial/transmural scar. Repolarization parameters were measured on an electrocardiogram performed prior to ICD implantation. After adjustment for potential confounders there was a strong association between the number of limited subendocardial (1-25% transmurality) scar segments and QTc (P = 0.003), QTD (P = 0.002), and Tpeak-end (P = 0.008). However, there was no association between the repolarization parameters and percent LV scar or the amount of transmural scar. During a mean follow-up of 19 ± 10 months 19 (30%) patients received appropriate ICD therapy, but none of the repolarization parameters were associated with its occurrence.

CONCLUSION: In this pilot study there was a strong association between limited subendocardial LV scar and prolonged QTc, QTD, and Tpeak-end. However, there was no association between any of these repolarization markers and the delivery of appropriate ICD therapy.

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More information

e-pub ahead of print date: 9 November 2012
Published date: June 2013
Keywords: arrhythmia, coronary artery disease, electrocardiogram, implantable cardioverter defibrillator, magnetic resonance imaging, sudden death
Organisations: Human Development & Health

Identifiers

Local EPrints ID: 355256
URI: http://eprints.soton.ac.uk/id/eprint/355256
ISSN: 1099-5129
PURE UUID: 0dc45ecb-b7a3-47ce-9912-1063c4bfc6c9
ORCID for N. Curzen: ORCID iD orcid.org/0000-0001-9651-7829

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Date deposited: 19 Aug 2013 13:01
Last modified: 09 Jan 2022 03:19

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Contributors

Author: Paul A. Scott
Author: James Rosengarten
Author: Anwar Shahed
Author: Arthur M. Yue
Author: David C. Murday
Author: Paul R. Roberts
Author: Charles Peebles
Author: Stephen P. Harden
Author: N. Curzen ORCID iD
Author: John M. Morgan

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