title: Diffuse Ventricular Fibrosis on Cardiac Magnetic Resonance Imaging Associates With Ventricular Tachycardia in Patients With Hypertrophic Cardiomyopathy.
abstract: Non-sustained ventricular tachycardia (NSVT) is a risk factor for sudden cardiac death (SCD) in patients with hypertrophic cardiomyopathy (HCM). We aimed to assess whether diffuse ventricular fibrosis on cardiac magnetic resonance (CMR) imaging could be a surrogate marker for ventricular arrhythmias in patients with HCM.
  
  
  
  A total of 100 patients with HCM (mean age 51 ± 13 years, septal wall thickness 20 ± 5 mm) underwent CMR with a 1.5 T scanner to determine the presence of ventricular late gadolinium enhancement (LGE) for focal fibrosis, and post-contrast T1 mapping for diffuse ventricular fibrosis. The presence of NSVT was determined by Holter monitoring and a subset of high risk patients received an implantable cardioverter-defibrillator (ICD).
  
  
  
  NSVT was detected in 23 of 100 patients with HCM. Focal ventricular fibrosis (by LGE) was observed in 87%, with no significant difference between patients with (96%) or without NSVT (86%, P = 0.19). However, LGE mass was greater in patients with (16.5 ± 19.1 g) versus without NSVT (7.6 ± 10.2 g, P < 0.01). NSVT was associated with a significant reduction in ventricular T1 relaxation time (422 ± 54 milliseconds) versus patients without NSVT (512 ± 115 milliseconds; P < 0.001). There was significant reduction in ventricular T1 relaxation time in patients with (430 ± 48 milliseconds) versus without aborted SCD (495 ± 113 milliseconds; P = 0.01) over a mean follow-up of 40 ± 10 months. On multivariate analysis post-contrast ventricular T1 relaxation time and septal wall thickness were the only predictors of NSVT.
  
  
  
  Post-contrast T1 relaxation time on CMR is associated with ventricular arrhythmias in patients with HCM. Diffuse ventricular fibrosis may be an important marker of arrhythmic risk in patients with HCM.
authors: Department of Cardiovascular Medicine, Alfred Hospital and Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia.|Cardiology Department, Royal Melbourne Hospital, Melbourne, Victoria, Australia.|Faculty of Medicine, Dentistry, and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia.
authors: Alex J A
authors: AJ
authors: McLELLAN
authors: Department of Cardiovascular Medicine, Alfred Hospital and Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia.
authors: Andris H
authors: AH
authors: Ellims
authors: Department of Cardiovascular Medicine, Alfred Hospital and Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia.|Cardiology Department, Royal Melbourne Hospital, Melbourne, Victoria, Australia.|Faculty of Medicine, Dentistry, and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia.
authors: Sandeep
authors: S
authors: Prabhu
authors: Department of Cardiovascular Medicine, Alfred Hospital and Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia.
authors: Alex
authors: A
authors: Voskoboinik
authors: Department of Cardiovascular Medicine, Alfred Hospital and Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia.
authors: Leah M
authors: LM
authors: Iles
authors: Department of Cardiovascular Medicine, Alfred Hospital and Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia.
authors: James L
authors: JL
authors: Hare
authors: Department of Cardiovascular Medicine, Alfred Hospital and Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia.
authors: David M
authors: DM
authors: Kaye
authors: Victorian Clinical Genetics Services, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.
authors: Ivan
authors: I
authors: Macciocca
authors: Department of Cardiovascular Medicine, Alfred Hospital and Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia.
authors: Justin A
authors: JA
authors: Mariani
authors: Cardiology Department, Royal Melbourne Hospital, Melbourne, Victoria, Australia.|Faculty of Medicine, Dentistry, and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia.
authors: Jonathan M
authors: JM
authors: Kalman
authors: Department of Cardiovascular Medicine, Alfred Hospital and Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia.
authors: Andrew J
authors: AJ
authors: Taylor
authors: Department of Cardiovascular Medicine, Alfred Hospital and Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia.|Cardiology Department, Royal Melbourne Hospital, Melbourne, Victoria, Australia.|Faculty of Medicine, Dentistry, and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia.
authors: Peter M
authors: PM
authors: Kistler
mesh_terms: D000328:Adult; D000368:Aged; D002312:Cardiomyopathy, Hypertrophic / Q000150:complications / Q000000981:diagnostic imaging* / Q000473:pathology / Q000503:physiopathology; D016009:Chi-Square Distribution; D003287:Contrast Media / Q000008:administration & dosage; D016757:Death, Sudden, Cardiac / Q000209:etiology / Q000517:prevention & control; D017147:Defibrillators, Implantable; D004554:Electric Countershock / Q000295:instrumentation; D015716:Electrocardiography, Ambulatory; D005260:Female; D005355:Fibrosis; D019786:Gadolinium DTPA / Q000008:administration & dosage; D006801:Humans; D016015:Logistic Models; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009206:Myocardium / Q000473:pathology*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012307:Risk Factors; D017180:Tachycardia, Ventricular / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy
chemical_list: D003287:Contrast Media; D019786:Gadolinium DTPA
keywords: MRI; cardiac magnetic resonance; hypertrophic cardiomyopathy; implantable cardioverter defibrillator; myocardial fibrosis; ventricular tachycardia