Extent of peri-infarct scar on late gadolinium enhancement cardiac magnetic resonance imaging and outcome in patients with ischemic cardiomyopathy.
Heart Rhythm. 2021 Jan 27;:
Authors: Tülümen E, Rudic B, Ringlage H, Hohneck A, Röger S, Liebe V, Kuschyk J, Overhoff D, Budjan J, Akin I, Borggrefe M, Papavassiliu T
BACKGROUND: Only a minority of patients who receive an implantable cardioverter defibrillator (ICD) based on left ventricular ejection fraction (LVEF) receive appropriate ICD therapy. Peri-infarct scar zone assessed by late gadolinium enhancement cardiovascular magnetic resonance (LGE-CMR) is possible substrate for ventricular tachyarrhytmias (VTA).
OBJECTIVE: The aim of our prospective study was to determine whether LGE-CMR parameters can predict the occurrence of VTA in patients with ischemic cardiomyopathy (ICM).
METHODS: 216 patients with ICM underwent CMR imaging prior to primary or secondary ICD implantation and were prospectively followed. We assessed CMR indices and CMR scar characteristics (infarct core and peri-infarct zone) to predict outcome and VTA.
RESULTS: Patients were followed for 1497 days (interquartile range 697-2237 days). Appropriate therapy occurred in 47 patients (21%) during follow-up. Patients with appropriate ICD therapy had smaller core scar (31.5 ± 8.5% vs 36.8 ± 8.9%, p = 0.0004) but larger peri-infarct scar (12.4 ± 2.6% vs 10.5 ± 2.9%, p = 0.0001) as compared to patients without appropriate therapy. In multivariable Cox regression analysis, peri-infarction scar (HR 1.15, 95%CI: 1.07-1.24, p=0.0001) was independently and significantly associated with VTA, whereas LVEF, RVEF, core scar and left atrial ejection fraction were not.
CONCLUSION: Scar extent of peri-infarct border zone was significantly associated with appropriate ICD therapy. Thus, LGE-CMR parameters can identify a subgroup of ICM patients with an increased risk of life-threatening VTA.
PMID: 33515714 [PubMed – as supplied by publisher]