Infarct tissue heterogeneity by magnetic resonance imaging identifies enhanced cardiac arrhythmia susceptibility in patients with left ventricular dysfunction
Infarct tissue heterogeneity by magnetic resonance imaging identifies enhanced cardiac arrhythmia susceptibility in patients with left ventricular dysfunction
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DOI：
10.1161/circulationaha.106.653568
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发表时间：
2007-04-17
期刊：
影响因子：
37.8
通讯作者：
Wu, Katherine C.
中科院分区：
文献类型：
--
作者：
Schmidt, Andre;Azevedo, Clerio F.;Wu, Katherine C.
磁共振成像（MRI）显示的梗死周围区范围与冠状动脉疾病患者的全因死亡率有关。这种关系可能是由于梗死边缘的血管生成所致。然而，梗死周边组织异质性与血管基质之间的关系尚未研究。在本研究中，我们通过对比增强MRI量化心肌梗死异质性，并将其与接受预防性植入式心律转复除颤器置入的左心室（LV）收缩功能障碍患者的心肌基质电生理标志物相关联。47例患者接受电影和对比增强MRI，以测量LV功能、体积、质量和梗死面积。描述了一种用于量化不均匀梗死周边和致密梗死核心的方法。MRI指标与电生理或器械测试期间持续性单形性室性心动过速的诱导相关。不可诱导组与诱导组的左室射血分数（30 ± 10% vs 29 ± 7%，P = 0.79）、左室舒张末期容积（220 ± 70 vs 228 ± 57 mL，P = 0.68）和标准对比增强MRI定义的梗死面积（P = NS）相似。梗死周边组织异质性的定量与单形性室性心动过速的诱导密切相关（不可诱导与诱导：13 +/- 9与19 +/- 8克，P = 0.015），是逐步logistic regression. Conclusions-组织异质性是存在的，并在人类梗死内可量化的单一重要因素。更广泛的组织异质性与程控电刺激引起的心室应激性增加相关。这些发现支持了解剖组织异质性增加既往心肌梗死和左室功能不全患者室性心律失常易感性的假设。
Background-The extent of the peri-infarct zone by magnetic resonance imaging (MRI) has been related to all-cause mortality in patients with coronary artery disease. This relationship may result from arrhythmogenesis in the infarct border. However, the relationship between tissue heterogeneity in the infarct periphery and arrhythmic substrate has not been investigated. In the present study, we quantify myocardial infarct heterogeneity by contrast-enhanced MRI and relate it to an electrophysiological marker of arrhythmic substrate in patients with left ventricular ( LV) systolic dysfunction undergoing prophylactic implantable cardioverter defibrillator placement.Methods and Results-Before implantable cardioverter defibrillator implantation for primary prevention of sudden cardiac death, 47 patients underwent cine and contrast-enhanced MRI to measure LV function, volumes, mass, and infarct size. A method for quantifying the heterogeneous infarct periphery and the denser infarct core is described. MRI indices were related to inducibility of sustained monomorphic ventricular tachycardia during electrophysiological or device testing. For the noninducible versus inducible patients, LV ejection fraction ( 30 +/- 10% versus 29 +/- 7%, P = 0.79), LV end-diastolic volume ( 220 +/- 70 versus 228 +/- 57 mL, P = 0.68), and infarct size by standard contrast-enhanced MRI definitions ( P = NS) were similar. Quantification of tissue heterogeneity at the infarct periphery was strongly associated with inducibility for monomorphic ventricular tachycardia ( noninducible versus inducible: 13 +/- 9 versus 19 +/- 8 g, P = 0.015) and was the single significant factor in a stepwise logistic regression.Conclusions-Tissue heterogeneity is present and quantifiable within human infarcts. More extensive tissue heterogeneity correlates with increased ventricular irritability by programmed electrical stimulation. These findings support the hypothesis that anatomic tissue heterogeneity increases susceptibility to ventricular arrhythmias in patients with prior myocardial infarction and LV dysfunction.