Scar extent evaluated by late gadolinium enhancement CMR: a powerful predictor of long term appropriate ICD therapy in patients with coronary artery disease.
Scar extent evaluated by late gadolinium enhancement CMR: a powerful predictor of long term appropriate ICD therapy in patients with coronary artery disease.
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DOI：
10.1186/1532-429x-15-12
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发表时间：
2013-01-19
期刊：
影响因子：
--
通讯作者：
Milliez P
中科院分区：
文献类型：
--
作者：
Alexandre J;Saloux E;Dugué AE;Lebon A;Lemaitre A;Roule V;Labombarda F;Provost N;Gomes S;Scanu P;Milliez P
冠状动脉疾病（CAD）患者存在与瘢痕组织相关的危及生命的室性心律失常（VA）风险。晚期钆增强心血管磁共振（LGE-CMR）能准确判断心肌瘢痕程度。研究表明，瘢痕程度，特别是瘢痕透壁性、瘢痕百分比和瘢痕质量，与适当的植入式心律转复除颤器（ICD）治疗的发生相关。然而，透壁程度的量化从未被研究过。本研究的目的是评价量化瘢痕透壁性、瘢痕百分比和瘢痕质量（使用LGE-CMR评估）的不同方法是否可以预测CAD患者的适当ICD治疗，并进行长期随访。我们回顾性纳入了66例在ICD植入前接受一级或二级预防性ICD植入和LGE-CMR的慢性CAD患者。使用LGE-CMR，通过使用四种不同方法测量瘢痕质量、瘢痕百分比和透壁瘢痕范围来评估瘢痕范围。中位随访时间为41.5个月（四分位距22-52）。终点是发生适当的器械治疗，发生在14例患者中。ICD前血运重建和透壁瘢痕程度与研究终点显著相关，但后者尤其高度依赖于所用方法。与未采用适当器械治疗的患者相比，采用适当器械治疗的患者的瘢痕质量更大（29.6 ± 14.5 g vs 17.1 ± 8.8 g，p = 0.004），瘢痕百分比更大（15.1 ± 8.2% vs 9.9 ± 5.6%，p = 0.03）。在多变量分析中，瘢痕程度变量与研究终点显著相关。在植入一级或二级预防性ICD的CAD患者的这项研究中，LGE-CMR研究的ICD前血运重建和瘢痕程度与适当的器械治疗显著相关，并且可以识别出具有危及生命的VA风险增加的CAD患者亚组。根据所使用的方法，透壁瘢痕程度可能会有显着差异，需要进一步研究，以获得一个有效的和一致的研究方法。
Coronary artery disease (CAD) patients are at risk for life-threatening ventricular arrhythmias (VA) related to scar tissue. Late gadolinium enhancement cardiovascular magnetic resonance (LGE-CMR) can accurately identify myocardial scar extent. It has been shown that scar extent, particularly scar transmurality, percent scar and scar mass, are associated with the occurrence of appropriate implantable cardioverter-defibrillator (ICD) therapy. However, quantification of transmurality extent has never been studied. The purpose of our study was to evaluate whether different methods quantifying scar transmurality, percent scar and scar mass (assessed with LGE-CMR) can predict appropriate ICD therapy in CAD patients with a long term follow-up period. We enrolled retrospectively 66 patients with chronic CAD referred for primary or secondary preventive ICD implantation and LGE-CMR before ICD implantation. Using LGE-CMR, scar extent was assessed by measuring scar mass, percent scar and transmural scar extent using four different methods. The median follow-up duration was 41.5 months (interquartile range 22–52). The endpoint was the occurrence of appropriate device therapy and occurred in 14 patients. Pre-ICD revascularization and transmural scar extent were significantly associated with the study endpoint but the latter was especially highly dependent on the method used. Patients with appropriate device therapy had also larger scar mass (29.6 ± 14.5 g vs 17.1 ± 8.8 g, p = 0.004), and larger percent scar (15.1 ± 8.2% vs 9.9 ± 5.6%, p = 0.03) than patients without appropriate device therapy. In multivariate analysis, scar extent variables remained significantly associated with the study end-point. In this study of CAD patients implanted for primary or secondary preventive ICD, pre-ICD revascularization and scar extent studied by LGE-CMR were significantly associated with appropriate device therapy and can identify a subgroup of CAD patients with an increased risk of life-threatening VA. Depending of the method used, transmural scar extent may vary significantly and needs further studies to obtain a validated and consensual study method.