Related Experiment Video
Updated: Mar 5, 2026
Isolation and Functional Characterization of Human Ventricular Cardiomyocytes from Fresh Surgical Samples
Published on: April 21, 2014
Myocardial Extracellular Volume Is Not Associated With Malignant Ventricular Arrhythmias in High-risk Hypertrophic
Jesús G Mirelis1, Javier Sánchez-González2, Esther Zorio3
1Área de Fisiopatología del Miocardio, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Instituto de Salud Carlos III, Madrid, Spain; CIBER de enfermedades CardioVasculares (CIBERCV), Spain; Departamento de Cardiología, Hospital Universitario Puerta de Hierro, Majahonda, Madrid, Spain.
Insights
In hypertrophic cardiomyopathy (HCM), computed tomography-determined extracellular volume (ECV) did not predict malignant ventricular arrhythmias in patients with implantable cardioverter-defibrillators. These findings suggest ECV is not a reliable predictor of arrhythmias in this high-risk population.
Area of Science:
- Cardiology
- Medical Imaging
- Biomedical Engineering
Background:
- Myocardial interstitial fibrosis is a key feature of hypertrophic cardiomyopathy (HCM) and is linked to arrhythmias.
- Extracellular volume (ECV) quantifies fibrosis and can be measured using computed tomography (CT).
Purpose of the Study:
- To investigate the association between CT-determined ECV and malignant ventricular arrhythmias in HCM patients.
- To determine if ECV can serve as a predictor for arrhythmias in high-risk HCM individuals.
Main Methods:
- A retrospective case-control study of 78 HCM patients with implantable cardioverter-defibrillators was conducted.
- CT scans with contrast infusion were used to calculate septal and lateral left ventricular ECV.
- ECV was compared between patients with and without prior malignant arrhythmias and across ECV tertiles.
Main Results:
- No significant difference in septal ECV was found between cases and controls (P = .282).
- Lateral ECV was significantly lower in cases compared to controls (P = .043).
- A trend suggested more appropriate shocks in the lowest lateral ECV tertile (P = .056).
Conclusions:
- CT-determined ECV was not elevated in HCM patients with malignant ventricular arrhythmias.
- The study does not support the use of ECV as a predictor of arrhythmias in high-risk HCM patients.
Introduction And Objectives:
Myocardial interstitial fibrosis, a hallmark of hypertrophic cardiomyopathy (HCM), has been proposed as an arrhythmic substrate. Fibrosis is associated with increased extracellular volume (ECV), which can be quantified by computed tomography (CT). We aimed to analyze the association between CT-determined ECV and malignant ventricular arrhythmias.
Methods:
A retrospective case-control observational study was conducted in HCM patients with implantable cardioverter-defibrillator, undergoing a CT-protocol with continuous iodine contrast infusion to determine equilibrium ECV. Left ventricular septal and lateral CT-determined ECV was compared between prespecified cases (malignant arrhythmia any time before CT scan) and controls (no prior malignant arrhythmias) and among ECV tertiles.
Results:
A total of 78 implantable cardioverter-defibrillator HCM patients were included; 24 were women, with a mean age of 52.1 ± 15.6 years. Mean ECV ± standard deviation in the septal left ventricular wall and was 29.8% ± 6.3% in cases (n = 24) vs 31.9% ± 8.5% in controls (n = 54); P = .282. Mean ECV in the lateral wall was 24.5% ± 6.8% in cases vs 28.2% ± 7.4% in controls; P = .043. On comparison of the entire population according to septal ECV tertiles, no significant differences were found in the number of patients receiving appropriate shocks. Conversely, we found a trend (P = .056) for a higher number of patients receiving appropriate shocks in the lateral ECV lowest tertile.
Conclusions:
Extracellular volume was not increased in implantable cardioverter-defibrillator HCM patients with malignant ventricular arrhythmias vs those without arrhythmias. Our findings do not support the use of ECV (a surrogate of diffuse fibrosis) as a predictor of arrhythmias in high-risk HCM patients.
Related Concept Videos
01:29Cardiomyopathy III: Hypertrophic Cardiomyopathy
01:29Cardiomyopathy V: Interprofessional Care
01:25Cardiomyopathy I: Introduction and Classification
01:29Heart Failure II: Pathophysiology
01:30Cardiomyopathy II: Dilated Cardiomyopathy
01:26Imbalances in Cardiac Output
CHF can occur due to the failure of either side of the heart. Left-side failure leads to pulmonary congestion—the right side continues to send...