Infarct tissue heterogeneity assessed with contrast-enhanced MRI predicts spontaneous ventricular arrhythmia in patients with ischemic cardiomyopathy and implantable cardioverter-defibrillator.
BACKGROUND
The relation between infarct tissue heterogeneity on contrast-enhanced MRI and the occurrence of spontaneous ventricular arrhythmia (or sudden cardiac death) is unknown. Therefore, the study purpose was to evaluate the predictive value of infarct tissue heterogeneity assessed with contrast-enhanced MRI on the occurrence of spontaneous ventricular arrhythmia with subsequent implantable cardioverter-defibrillator (ICD) therapy (as surrogate of sudden cardiac death) in patients with previous myocardial infarction.


RESULTS
Ninety-one patients (age, 65+/-11 years) with previous myocardial infarction scheduled for ICD implantation underwent cine MRI to evaluate left ventricular function and volumes and contrast-enhanced MRI for characterization of scar tissue (infarct gray zone as measure of infarct tissue heterogeneity, infarct core, and total infarct size). Appropriate ICD therapy was documented in 18 patients (20%) during a median follow-up of 8.5 months (interquartile range, 2.1 to 20.3). Multivariable Cox proportional hazards analysis revealed that infarct gray zone was the strongest predictor of the occurrence of spontaneous ventricular arrhythmia with subsequent ICD therapy (hazard ratio, 1.49/10 g; CI, 1.01 to 2.20; chi(2)=4.0; P=0.04).


CONCLUSIONS
Infarct tissue heterogeneity on contrast-enhanced MRI is the strongest predictor of spontaneous ventricular arrhythmia with subsequent ICD therapy (as surrogate of sudden cardiac death) among other clinical and MRI variables, that is, total infarct size and left ventricular function and volumes, in patients with previous myocardial infarction.
Roes
Stijntje D
SD
Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands. s.d.roes@lumc.nl
Borleffs
C Jan Willem
CJ
van der Geest
Rob J
RJ
Westenberg
Jos J M
JJ
Marsan
Nina Ajmone
NA
Kaandorp
Theodorus A M
TA
Reiber
Johan H C
JH
Zeppenfeld
Katja
K
Lamb
Hildo J
HJ
de Roos
Albert
A
Schalij
Martin J
MJ
Bax
Jeroen J
JJ
D000368:Aged; D001145:Arrhythmias, Cardiac / Q000209:etiology / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D009202:Cardiomyopathies / Q000209:etiology / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D003287:Contrast Media; D016757:Death, Sudden, Cardiac / Q000209:etiology / Q000473:pathology / Q000517:prevention & control*; D017147:Defibrillators, Implantable; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D009206:Myocardium / Q000473:pathology*; D015588:Observer Variation; D018579:Patient Selection; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000209:etiology / Q000401:mortality / Q000473:pathology / Q000628:therapy*
D003287:Contrast Media