Entropy as a Novel Measure of Myocardial Tissue Heterogeneity for Prediction of Ventricular Arrhythmias and Mortality in Post-Infarct Patients
Entropy as a Novel Measure of Myocardial Tissue Heterogeneity for Prediction of Ventricular Arrhythmias and Mortality in Post-Infarct Patients
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DOI：
10.1016/j.jacep.2018.12.005
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发表时间：
2019-04-01
影响因子：
7
通讯作者：
Tao, Qian
中科院分区：
文献类型：
--
作者：
Androulakis, Alexander F. A.;Zeppenfeld, Katja;Tao, Qian
本研究提出熵作为一个新的晚期钆增强心脏磁共振衍生参数，以评估组织的不均匀性，独立于信号强度阈值。本研究假设瘢痕内的熵与室性心律失常（VA）相关，而整个左心室（LV）心肌的熵与mortality.BACKGROUND在心肌梗死后的患者中，纤维化的异质性决定了VA的基质。偏远地区的纤维化与心力衰竭和死亡率有关。晚期钆增强心脏磁共振已被用来描绘纤维化，但可用的方法依赖于信号强度阈值和结果一直unconsistent.METHODS连续心肌梗死后患者接受晚期钆增强心脏磁共振植入式心律转复除颤器植入术前被包括在内。从心脏磁共振成像，总瘢痕大小，瘢痕灰区，瘢痕透壁，和组织熵。随访患者接受适当的植入式心律转复除颤器治疗和死亡率。结果共纳入154例患者（年龄64 +/- 10岁，84%为男性，左心室射血分数29 +/-10%，47%为急性血运重建）。在中位随访56个月（四分位距：40 - 73）期间，46例患者（30%）接受了适当的植入式心律转复除颤器治疗，41例患者（27%）死亡。多变量分析显示，在校正多支血管疾病、急性血运重建、左心室射血分数、瘢痕灰区和透壁性后，瘢痕的高熵（风险比[HR]：1.9; 95%置信区间[CI]：1.0 - 3.5; p = 0.042）与VA独立相关。整个LV的熵与死亡率独立相关（HR：3.2; 95%CI：1.1 ~ 9.9; p = 0.038）。结论瘢痕内的高熵与VA相关，可能提示致瘤性瘢痕。整个LV的高熵与死亡率相关，并可能反映了与不良重塑相关的纤维化模式。(C)2019年由美国心脏病学会基金会。
OBJECTIVES This study proposed entropy as a new late gadolinium enhanced cardiac magnetic resonance-derived parameter to evaluate tissue inhomogeneity, independent of signal intensity thresholds. This study hypothesized that entropy within the scar is associated with ventricular arrhythmias (VAs), whereas entropy of the entire left ventricular (LV) myocardium is associated with mortality.BACKGROUND In patients after myocardial infarction, the heterogeneity of fibrosis determines the substrate for VA. Fibrosis in remote areas has been associated with heart failure and mortality. Late gadolinium-enhanced cardiac magnetic resonance has been used to delineate fibrosis, but available methods depend on signal intensity thresholds and results have been inconsistent.METHODS Consecutive post-myocardial infarction patients undergoing late gadolinium enhanced cardiac magnetic resonance prior to implantable cardioverter-defibrillator implantation were included. From cardiac magnetic resonance imaging, total scar size, scar gray zone, scar transmurality, and tissue entropy were derived. Patients were followed for appropriate implantable cardioverter-defibrillator therapy and mortality.RESULTS A total of 154 patients (age 64 +/- 10 years, 84% male, LV ejection fraction 29 +/- 10%, 47% acute revascularization) were included. During a median follow-up of 56 (interquartile range: 40 to 73) months, appropriate implantable cardioverter-defibrillator therapy occurred in 46 patients (30%), and 41 patients (27%) died. From multivariable analysis, higher entropy of the scar (hazard ratio [HR]: 1.9; 95% confidence interval [CI]: 1.0 to 3.5; p = 0.042) was independently associated with VA, after adjusting for multivessel disease, acute revascularization, LV ejection fraction, scar gray zone, and transmurality. Entropy of the entire LV was independently associated with mortality (HR: 3.2; 95% CI: 1.1 to 9.9; p = 0.038).CONCLUSIONS High entropy within the scar was associated with VA and may indicate an arrhythmogenic scar. High entropy of the entire LV was associated with mortality and may reflect a fibrosis pattern associated with adverse remodeling. (C) 2019 by the American College of Cardiology Foundation.