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Greyzone myocardial fibrosis and ventricular arrhythmias in patients with a left ventricular ejection fraction >35

Abbasin Zegard1,2, Osita Okafor1,2, Joseph de Bono2

  • 1Aston Medical School, Aston University, Birmingham, UK.

Europace : European Pacing, Arrhythmias, and Cardiac Electrophysiology : Journal of the Working Groups on Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology
|August 11, 2021
PubMed

Insights

Greyzone fibrosis (GZF) on cardiovascular magnetic resonance (CMR) strongly predicts ventricular arrhythmias in coronary artery disease (CAD) patients with preserved ejection fraction. This finding aids in identifying high-risk individuals for sudden cardiac events.

Area of Science:

  • Cardiovascular Imaging
  • Cardiac MRI
  • Myocardial Fibrosis

Background:

  • Myocardial fibrosis is a key substrate for ventricular arrhythmias.
  • Greyzone fibrosis (GZF) represents an intermediate stage of fibrosis.
  • Its role in patients with coronary artery disease (CAD) and preserved ejection fraction requires further elucidation.

Purpose of the Study:

  • To investigate the association between GZF and ventricular arrhythmias.
  • To assess cardiovascular magnetic resonance (CMR) findings in patients with CAD and left ventricular ejection fraction (LVEF) >35%.

Main Methods:

  • Retrospective analysis of 701 CAD patients with LVEF >35%.
  • Quantification of GZF mass (GZF3SD) and total fibrosis mass (TF2SD) using CMR.
  • Evaluation of association with a composite endpoint of sudden cardiac death, ventricular tachycardia, or fibrillation.

Main Results:

  • A GZF3SD mass ≥5.0 g was strongly associated with the arrhythmic endpoint (sHR: 17.4, AUC: 0.85).
  • TF2SD mass ≥23 g showed a weaker association (sHR: 10.4, AUC: 0.80).
  • GZF3SD demonstrated a wider range of hazard ratios compared to TF2SD.

Conclusions:

  • In CAD patients with LVEF >35%, GZF mass on CMR is a strong predictor of arrhythmic events.
  • GZF quantification holds promise for risk stratification in this patient population.
  • These findings may improve identification of patients at risk for sudden cardiac death.
Abstract

Keywords:
Cardiovascular magnetic resonanceCoronary artery diseaseGreyzone scarMyocardial fibrosisSudden cardiac deathVentricular fibrillationVentricular tachycardia

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