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Conductive channels identified with contrast-enhanced MR imaging predict ventricular tachycardia in systolic heart
Lian-Yu Lin1, Mao-Yuan M Su, Jien-Jiun Chen
1Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Insights
Identifying the conductive channel (CC) via late gadolinium enhanced-cardiac magnetic resonance (LGE-CMR) can help identify patients with heart failure (HF) at risk for ventricular tachycardia (VT). This imaging technique shows a higher probability of CC identification in patients experiencing VT/VF or mortality.
Area of Science:
- Cardiology
- Medical Imaging
- Electrophysiology
Background:
- Late gadolinium enhanced-cardiac magnetic resonance (LGE-CMR) can detect conductive channels (CC) formed by heterogeneous tissue within myocardial scar.
- These CCs are implicated as the source of ventricular tachycardia (VT) in patients.
Purpose of the Study:
- To evaluate the association between CCs identified by LGE-CMR and the occurrence of VT in patients with systolic heart failure (HF).
- To determine if CC identification can predict VT risk in HF patients.
Main Methods:
- Sixty-three patients with left ventricular ejection fraction (LVEF) < 50% and LGE-CMR hyperenhancement were analyzed.
- Cardiac magnetic resonance (CMR) imaging was used to assess LV function, scar characteristics, and identify CCs.
- Patient outcomes, including VT, ventricular fibrillation (VF), and mortality, were tracked via medical records.
Main Results:
- CC identification by LGE-CMR was significantly higher in patients who experienced VT/VF (75.0%) compared to those who did not (16.4%, p < 0.001).
- CC identification was also significantly higher in patients who died (50.0%) versus survivors (16.3%, p = 0.004).
- CC identification was positively associated with VT/VF (HR: 27.032) and mortality (HR: 4.766), while LVEF was inversely associated with both outcomes.
Conclusions:
- LGE-CMR identification of the conductive channel (CC) is a significant predictor of VT/VF events in patients with systolic heart failure.
- This imaging approach can aid in identifying HF patients at higher risk for life-threatening ventricular arrhythmias.
Objectives:
This study evaluated whether the conductive channel (CC) identified by late gadolinium enhanced-cardiac magnetic resonance (LGE-CMR) is associated with ventricular tachycardia (VT) in patients with systolic heart failure (HF).
Background:
One recent study demonstrated that the CC formed by heterogeneous tissue within the core scar could be detected by LGE-CMR and that the CC is responsible for clinical VT. We hypothesized that the CC could help identify HF patients at risk for VT.
Methods:
A total of 63 patients from a CMR database with left ventricular ejection fraction (LVEF) below 50% and with hyperenhancement on LGE-CMR were included. The cine and LGE images were analyzed to derive the LV function and scar characteristics, and to identify the CC. The outcomes, including VT, ventricular fibrillation (VF), and total mortality, were obtained by reviewing medical records.
Results:
After a median 1,379 (interquartile range: 271 to 1,896) days of follow-up, 8 patients had VT/VF attacks and 14 patients died. Among the CMR-measured parameters, only the probability of identifying the CC by LGE-CMR was higher in patients with VT/VF than those without VT/VF (75.0% vs. 16.4%, p < 0.001). The probability of identifying the CC was also higher in the total mortality group than the survival group (50.0% vs. 16.3%, p = 0.004). The other LGE-CMR variables were not significantly different between the 2 groups. A univariate Cox regression model showed that CC identification was positively associated with VT/VF attacks (hazard ratio [HR]: 27.032, 95% confidence interval [CI]: 3.291 to 222.054, p = 0.002) and excess total mortality (HR: 4.766, 95% CI: 1.643 to 13.824, p = 0.004). The LVEF was inversely associated with VT/VF attacks (HR: 0.119, 95% CI: 0.015 to 0.977, p = 0.048) and excess total mortality (HR: 0.491, 95% CI: 0.261 to 0.925, p = 0.028) during follow-up.
Conclusions:
We demonstrated that CC identification using LGE-CMR can help identify HF patients at risk for VT/VF.
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