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Infarct characteristics by CMR identifies substrate for monomorphic VT in post-MI patients with relatively preserved

Kivanc Yalin1, Ebru Golcuk, Hakan Buyukbayrak

  • 1Department of Cardiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.

Pacing and Clinical Electrophysiology : PACE
|November 13, 2013
PubMed
Abstract

Insights

In post-MI patients with preserved ejection fraction, larger peri-infarct zone (PIZ) and total scar (TS) size identified by contrast-enhanced cardiac magnetic resonance (ce-CMR) predict ventricular arrhythmia inducibility. These findings suggest ce-CMR can identify arrhythmia substrates.

Area of Science:

  • Cardiology
  • Medical Imaging
  • Electrophysiology

Background:

  • Peri-infarct zone (PIZ) extent on contrast-enhanced cardiac magnetic resonance (ce-CMR) correlates with ventricular arrhythmia inducibility in ischemic cardiomyopathy.
  • This relationship is less understood in post-myocardial infarction (post-MI) patients with preserved left ventricular (LV) systolic function.

Purpose of the Study:

  • Investigate the association between myocardial scar characteristics (size and type) and ventricular arrhythmia inducibility.
  • Evaluate the utility of ce-CMR in identifying arrhythmia substrates in post-MI patients with relatively preserved LV function.

Main Methods:

  • Enrolled 28 post-MI patients with LVEF 40-50% and non-sustained ventricular tachycardia.
  • Performed cine and gadolinium-enhanced MRI before programmed ventricular stimulation (PVS).
  • Quantified total scar (TS), dense scar (DS), and PIZ using a computer-assisted algorithm based on signal intensity thresholds.

Main Results:

  • No significant difference in DS percent between inducible and non-inducible groups.
  • Higher PIZ percent (28.02% vs 19.86%, P=0.01) and TS percent (31.14% vs 23.31%, P=0.02) were associated with ventricular arrhythmia inducibility.
  • PIZ percent (OR 1.18) and TS percent (OR 1.15) were independent predictors of inducibility in multivariate analysis.

Conclusions:

  • Increased PIZ and TS percent correlate with higher ventricular arrhythmia inducibility in post-MI patients with preserved LV function.
  • ce-CMR can effectively identify the myocardial substrate for ventricular arrhythmias in this patient population.
Keywords:
cardiac magnetic resonanceelectrophysiologic studypost-myocardial infarctionpreserved left ventricular functionprogrammed ventricular stimulationscarventricular tachycardia

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