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The Relationship between Cardiac Magnetic Resonance-Assessed Replacement and Interstitial Fibrosis and Ventricular

Aleksandra Karabinowska-Małocha1, Ewa Dziewięcka1, Paweł Banyś2

  • 1Department of Cardiac and Vascular Diseases, Jagiellonian University Medical College, John Paul II Hospital, Prądnicka Street 80, 31-202 Krakow, Poland.

Journal of Personalized Medicine
|February 25, 2022
PubMed

Insights

The extent of late gadolinium enhancement (LGE) on cardiac MRI, not just its presence, predicts non-sustained ventricular tachycardia (nsVT) in hypertrophic cardiomyopathy (HCM) patients. Interstitial fibrosis showed no association with nsVT.

Area of Science:

  • Cardiology
  • Medical Imaging
  • Electrophysiology

Background:

  • Non-sustained ventricular tachycardia (nsVT) is a significant risk factor for sudden cardiac death (SCD) in hypertrophic cardiomyopathy (HCM).
  • Cardiac magnetic resonance (CMR) imaging can assess myocardial fibrosis, a key substrate for arrhythmias in HCM.

Purpose of the Study:

  • To investigate the relationship between interstitial and replacement fibrosis, assessed by CMR, and the occurrence of nsVT in HCM patients.
  • To determine if CMR-derived fibrosis measures predict nsVT in this population.

Main Methods:

  • Fifty HCM patients underwent 3 Tesla CMR to quantify late gadolinium enhancement (LGE) for replacement fibrosis and native T₁, post-contrast T₁, and extracellular volume (ECV) for interstitial fibrosis.
  • Patients were monitored with Holter to detect nsVT.
  • Statistical analyses, including multivariable regression, were used to assess the association between fibrosis and nsVT.

Main Results:

  • nsVT was detected in 28% of HCM patients.
  • While LGE was present in 74% of patients, only the extent of LGE, not its mere presence, showed a significant association with nsVT (p=0.002).
  • The extent of LGE was an independent predictor of nsVT (OR 1.2; p=0.02), whereas interstitial fibrosis measures did not correlate with nsVT.

Conclusions:

  • The extent of LGE on CMR is a crucial determinant of nsVT occurrence in HCM patients.
  • Interstitial fibrosis assessment by CMR did not show a significant relationship with nsVT in this cohort.
  • CMR-derived LGE extent is a valuable tool for risk stratification of nsVT in HCM.

Keywords:
ECVLGEhypertrophic cardiomyopathymyocardial fibrosis

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