title: Scar characteristics for prediction of ventricular arrhythmia in ischemic cardiomyopathy.
abstract: BACKGROUND
  Better risk-stratification tools are needed to identify the best candidates for implantable cardioverter defibrillator implantation. Infarct characterization by cardiac magnetic resonance (CMR) has become an evolving potential tool for risk stratification.
  
  
  OBJECTIVE
  We assessed the ability of scar characteristics by CMR in patients with postinfarction left ventricular (LV) dysfunction to predict sustained monomorphic ventricular tachycardia (SMVT).
  
  
  METHODS
  Forty-eight patients with postinfarction LV dysfunction underwent CMR study. Twenty-four patients had history of SMVT and the other 24 were control group and underwent electrophysiological study to assess SMVT inducibilty. Various scar characteristics were assessed in the spontaneous SMVT group and were compared with the inducible and noninducible SMVT groups.
  
  
  RESULTS
  Only six patients in the control group had inducible SMVT. In univariable analysis, total scar (absolute and as percent of LV), scar core (absolute and as percent of LV), peri-infarct zone (absolute and as percent of LV), mean infarct transmurality, and number of segments with late gadolinium enhancement (LGE) were statistically significant predictors of spontaneous SMVT experience and SMVT inducibility. In multivariable analysis, total infarct as percent of LV mass was the only significant independent predictor of spontaneous SMVT experience (odds ratio [OR] 1.33 per% change, 95% confidence interval [CI] 1.12-1.6, P = 0.001) and SMVT inducibility (OR 1.3 per% change, 95% CI 1.1-1.6, P = 0.004).
  
  
  CONCLUSIONS
  Characterization of myocardial infarct by LGE-CMR, specifically total infarct size, is better predictor of spontaneous SMVT experience and SMVT inducibility than LV ejection fraction.
authors.affiliation: Department of Cardiovascular Medicine, Cairo University, Cairo, Egypt.
authors.forename: Sherif
authors.initials: S
authors.lastname: Gouda
authors.forename: Amir
authors.initials: A
authors.lastname: Abdelwahab
authors.forename: Mohamed
authors.initials: M
authors.lastname: Salem
authors.forename: Magdy Abdel
authors.initials: MA
authors.lastname: Hamid
mesh_terms: D002921:Cicatrix / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000503:physiopathology*; D011237:Predictive Value of Tests; D011379:Prognosis; D018570:Risk Assessment; D012307:Risk Factors; D017180:Tachycardia, Ventricular / Q000503:physiopathology*; D018487:Ventricular Dysfunction, Left / Q000503:physiopathology*
keywords: cardiac magnetic resonance; ischemic cardiomyopathy; sudden cardiac death; ventricular tachycardia