title: A comparison of cardiac magnetic resonance imaging peri-infarct border zone quantification strategies for the prediction of ventricular tachyarrhythmia inducibility.
abstract: BACKGROUND
  Peri-infarct border zone (BZ) as quantified by late gadolinium enhancement (LGE) on cardiac magnetic resonance imaging (MRI) has been proposed as a risk stratification tool, and is associated with increased mortality. BZ has been measured by various methods in the literature. We assessed which BZ analysis best predicts inducible arrhythmia during electrophysiological study (EPS).
  
  
  METHODS
  LGE was performed in 47 patients with coronary artery disease referred for EPS to assess for ventricular tachycardia (VT). LGE data was analyzed for BZ quantification by 3 previously published methods. Method I (BZ-I) used pixels 2-3 standard deviations over the mean of normal tissue, expressed as % of left ventricular mass, Method II (BZ-II, as described by Yan) and Method III (BZ-III, as described by Schmidt). EPS results were classified as negative (non-inducible) or positive (monomorphic VT - MVT).
  
  
  RESULTS
  There were 47 subjects-age 61.7 years, 72% male. During EPS, 20 patients were non-inducible and 18 had induced MVT. Ejection fraction was not significantly different between non-inducible patients and those with MVT (34.1% vs. 28.5%, p = 0.13). BZ-I was significantly different (1.4% vs. 2.6%, p = 0.001), but not BZ-II (7.9% vs. 6.9%, p = 0.68) or BZ-III (2.7 g vs. 2.1 g, p = 0.88). Multivariate analysis demonstrated that only BZ-I was an independent predictor of EPS outcome after controling for infarct size (OR 1.97 per % change, 95% CI 1.04-3.73, p = 0.04).
  
  
  CONCLUSIONS
  This study demonstrates significant variability between the published methods for measuring BZ. Also, BZ-I is a stronger predictor of inducible MVT during EPS than ejection fraction and infarct size. BZ may be another LGE marker of elevated risk of arrhythmia.
authors.forename: Jason C
authors.initials: JC
authors.lastname: Rubenstein
authors.forename: Daniel C
authors.initials: DC
authors.lastname: Lee
authors.forename: Edwin
authors.initials: E
authors.lastname: Wu
authors.forename: Alan H
authors.initials: AH
authors.lastname: Kadish
authors.forename: Rod
authors.initials: R
authors.lastname: Passman
authors.forename: David
authors.initials: D
authors.lastname: Bello
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Goldberger
mesh_terms: D000368:Aged; D057791:Cardiac Imaging Techniques / Q000379:methods*; D016757:Death, Sudden, Cardiac / Q000453:epidemiology / Q000473:pathology; D005260:Female; D005682:Gadolinium; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications* / Q000401:mortality / Q000473:pathology*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D013318:Stroke Volume; D017180:Tachycardia, Ventricular / Q000209:etiology* / Q000401:mortality / Q000473:pathology*
chemical_list: D005682:Gadolinium