Scar size and characteristics assessed by CMR predict ventricular arrhythmias in ischaemic cardiomyopathy: comparison of previously validated models
Scar size and characteristics assessed by CMR predict ventricular arrhythmias in ischaemic cardiomyopathy: comparison of previously validated models
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DOI：
10.1136/heartjnl-2011-300060
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发表时间：
2011-12-01
期刊：
影响因子：
5.7
通讯作者：
Allaart, Cornelis P.
中科院分区：
文献类型：
--
作者：
de Haan, Stefan;Meijers, Thomas A.;Allaart, Cornelis P.
目的心源性猝死是缺血性心肌病患者的主要死亡原因。风险分层仍然具有挑战性。目前，有越来越多的兴趣，疤痕的特点评估作为一个预测心脏性猝死使用心脏磁共振成像（CMR）。缺乏标准的分析方法。本研究评估了以前验证的方法的瘢痕评估CMR与晚钆增强（LGE）在其预测室性快速性心律失常的能力。方法缺血性心肌病患者接受植入式心律转复除颤器进行一级预防，并在其中进行LGE-CMR，包括在内。瘢痕核心大小，周围梗死区和总瘢痕大小，这是定义为核心大小和周围梗死区的总和，进行了评估，使用三个先前验证过的模型，并预测室性快速性心律失常的能力evaluated.Results五十五例患者（平均年龄64.6 +/- 10.8岁，43名男性）。在中位随访2.0年（IQR 1.0-3.0年）期间，26%的患者达到室性快速性心律失常终点。三种方法的所有瘢痕特征（即总瘢痕大小、瘢痕核心大小和梗死周围区）均为终点的预测因子（p < 0.01）。总瘢痕大小相当，而瘢痕核心大小和梗死周围区在测试模型之间变化显著。不同瘢痕特征的受试者工作特征曲线的曲线下面积在0.721 ~ 0.812之间。结论LGE-CMR瘢痕组织特征对缺血性心肌病患者室性心律失常的发生具有预测价值。对瘢痕核心大小和/或梗死周围区的额外估计似乎并不能增加单独的总瘢痕大小的诊断准确性。
Objective Sudden cardiac death is a major cause of mortality in patients with ischaemic cardiomyopathy. Risk stratification remains challenging. Currently, there is growing interest in scar characteristic assessment as a predictor of sudden cardiac death using cardiac magnetic resonance imaging (CMR). Standard analysis methods are lacking. The present study evaluated previously validated methods of scar assessment by CMR with late gadolinium enhancement (LGE) in their ability to predict ventricular tachyarrhythmias.Methods Patients with ischaemic cardiomyopathy who received an implantable cardioverter defibrillator for primary prevention and in whom a LGE-CMR was performed, were included. Scar core size, peri-infarct zone and total scar size, which is defined as the sum of the core size and peri-infarct zone, were assessed using three previously validated models, and their ability to predict ventricular tachyarrhythmias was evaluated.Results Fifty-five patients were included (mean age 64.6 +/- 10.8 years, 43 men). During a median follow-up of 2.0 years (IQR 1.0-3.0 years) 26% of patients reached the endpoint of ventricular tachyarrhythmia. All scar characteristics (ie, total scar size, scar core size and peri-infarct zone) of the three methods were predictors of the endpoint (p < 0.01). Total scar size was comparable, whereas scar core size and peri-infarct zone varied significantly between the tested models. Receiver operating characteristic curves of the different scar characteristics showed comparable areas under the curve varying from 0.721 to 0.812.Conclusions LGE-CMR-derived scar tissue characteristics are of predictive value for the occurrence of ventricular tachyarrhythmias in patients with ischaemic cardiomyopathy. Additional estimation of scar core size and/or peri-infarct zone does not appear to increase the diagnostic accuracy over total scar size alone.