Late-Gadolinium Enhancement Interface Area and Electrophysiological Simulations Predict Arrhythmic Events in Patients With Nonischemic Dilated Cardiomyopathy.
Late-Gadolinium Enhancement Interface Area and Electrophysiological Simulations Predict Arrhythmic Events in Patients With Nonischemic Dilated Cardiomyopathy.
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晚期钆增强界面面积和电生理模拟预测非缺血性扩张型心肌病患者的心律失常事件
DOI：
10.1016/j.jacep.2020.08.036
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发表时间：
2021-03
期刊：
影响因子：
--
通讯作者：
Bishop MJ
中科院分区：
文献类型：
--
作者：
Balaban G;Halliday BP;Porter B;Bai W;Nygåard S;Owen R;Hatipoglu S;Ferreira ND;Izgi C;Tayal U;Corden B;Ware J;Pennell DJ;Rueckert D;Plank G;Rinaldi CA;Prasad SK;Bishop MJ
本研究旨在研究基于形状的晚期钆增强（LGE）指标和折返电活动模拟是否与非缺血性扩张型心肌病（NIDCM）患者的心肌事件相关。在NIDCM中，LGE的存在预示着危及生命的室性心律失常;然而，风险分层仍然不准确。LGE形状和电活动的模拟可能能够提供额外的预后信息。计算了156例NIDCM和可见LGE患者的心脏磁共振（CMR）-LGE形状指标，并回顾性检测了与心源性猝死和室性心动过速的药物复合终点的相关性。根据图像创建计算模型，并与模拟刺激方案结合使用，以评估每例患者瘢痕形态中的折返诱导潜力。对模拟进行了机制分析以解释这些关联。在中位随访1，611（四分位距：881 - 2，341）天期间，16例患者（10.3%）达到主要终点。在逆概率加权考克斯回归中，LGE-心肌界面面积（风险比[HR]：1.75; 95%置信区间[CI]：1.24 - 2.47; p = 0.001），模拟再入组次数（HR：1.40; 95% CI：1.23至1.59; p < 0.01）和LGE体积（HR：1.44; 95% CI：1.07至1.94; p = 0.02）与药物事件相关。计算模型揭示了复极异质性和LGE-心肌界面的电波阵面的速率依赖性阻滞，这是与LGE界面面积直接相关的假定致心律失常机制。瘢痕和存活心肌之间的界面面积以及模拟的折返活动与NIDCM和LGE患者的主要心肌事件风险升高相关，并代表了新的风险预测因子。
This study sought to investigate whether shape-based late gadolinium enhancement (LGE) metrics and simulations of re-entrant electrical activity are associated with arrhythmic events in patients with nonischemic dilated cardiomyopathy (NIDCM). The presence of LGE predicts life-threatening ventricular arrhythmias in NIDCM; however, risk stratification remains imprecise. LGE shape and simulations of electrical activity may be able to provide additional prognostic information. Cardiac magnetic resonance (CMR)-LGE shape metrics were computed for a cohort of 156 patients with NIDCM and visible LGE and tested retrospectively for an association with an arrhythmic composite endpoint of sudden cardiac death and ventricular tachycardia. Computational models were created from images and used in conjunction with simulated stimulation protocols to assess the potential for re-entry induction in each patient’s scar morphology. A mechanistic analysis of the simulations was carried out to explain the associations. During a median follow-up of 1,611 (interquartile range: 881 to 2,341) days, 16 patients (10.3%) met the primary endpoint. In an inverse probability weighted Cox regression, the LGE–myocardial interface area (hazard ratio [HR]: 1.75; 95% confidence interval [CI]: 1.24 to 2.47; p = 0.001), number of simulated re-entries (HR: 1.40; 95% CI: 1.23 to 1.59; p < 0.01) and LGE volume (HR: 1.44; 95% CI: 1.07 to 1.94; p = 0.02) were associated with arrhythmic events. Computational modeling revealed repolarization heterogeneity and rate-dependent block of electrical wavefronts at the LGE–myocardial interface as putative arrhythmogenic mechanisms directly related to the LGE interface area. The area of interface between scar and surviving myocardium, as well as simulated re-entrant activity, are associated with an elevated risk of major arrhythmic events in patients with NIDCM and LGE and represent novel risk predictors.
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DOI：
10.1016/j.jcmg.2018.07.015
发表时间：
2019-08
期刊：
JACC. Cardiovascular imaging
影响因子：
--
作者：
Halliday BP;Baksi AJ;Gulati A;Ali A;Newsome S;Izgi C;Arzanauskaite M;Lota A;Tayal U;Vassiliou VS;Gregson J;Alpendurada F;Frenneaux MP;Cook SA;Cleland JGF;Pennell DJ;Prasad SK
通讯作者：
Prasad SK
影响因子：
37.8
作者：
Schmidt, Andre;Azevedo, Clerio F.;Wu, Katherine C.
通讯作者：
Wu, Katherine C.
影响因子：
39.3
作者：
Glashan, Claire A.;Androulakis, Alexander F. A.;Zeppenfeld, Katja
通讯作者：
Zeppenfeld, Katja
影响因子：
7.5
作者：
Jablonowski, Robert;Chaudhry, Uzma;Carlsson, Marcus
通讯作者：
Carlsson, Marcus
影响因子：
1.3
作者：
Vigmond, EJ;Hughes, M;Leon, LJ
通讯作者：
Leon, LJ