title: Comparison of Ventricular Inducibility with Late Gadolinium Enhancement and Myocardial Inflammation in Endomyocardial Biopsy in Patients with Dilated Cardiomyopathy.
abstract: BACKGROUND
  Risk stratification of patients with non-ischemic dilated cardiomyopathy remains a matter of debate in the era of device implantation.
  
  
  OBJECTIVE
  We investigated associations between histopathological findings, contrast-enhanced cardiac MRI and the inducibility of ventricular tachycardia (VT) or fibrillation (VF) in programmed ventricular stimulation.
  
  
  METHODS
  56 patients with impaired left ventricular ejection fraction (LVEF≤50%, mean 36.6±10.5%) due to non-ischemic dilated cardiomyopathy underwent cardiac MRI, programmed ventricular stimulation, and endomyocardial biopsy and were retrospectively investigated. Inducibility was defined as sustained mono- or polymorphic VT or unstable VT/VF requiring cardioversion/defibrillation. Primary study endpoint was defined as the occurrence of hemodynamically relevant VT/VF and/or adequate ICD-therapy during follow-up.
  
  
  RESULTS
  Endomyocardial biopsy detected cardiac fibrosis in 18 (32.1%) patients. Cardiac MRI revealed 35 (62.5%) patients with positive late gadolinium enhancement. VT/VF was induced in ten (17.9%) patients during programmed ventricular stimulation. Monomorphic VT was inducible in 70%, while 20% of patients showed polymorphic VT. One patient (10%) presented with VF. Inducibility correlated significantly with the presence of positive late gadolinium enhancement in cardiac MRI (p<0.01). We could not find a significant association between inducibility and the degree of cardiac inflammation and fibrosis in non-site directed routine right ventricular endomyocardial biopsy. During a mean follow-up of 2.6 years, nine (16.1%) patients reached the primary endpoint. Monomorphic VTs were found in 66.7% patients and were terminated by antitachycardia pacing therapy. One patient with polymorphic VT and two patients with VF received adequate therapy by an ICD-shock. However, inducibility did not correlate with the occurrence of endpoints.
  
  
  CONCLUSIONS
  Inducibilty during programmed ventricular stimulation is associated with positive late gadolinium enhancement in cardiac MRI of patients with non-ischemic dilated cardiomyopathy. The presence of myocardial fibrosis or inflammation in undirected endomyocardial biopsy does not seem to be sufficient to predict future ventricular arrhythmias.
authors.affiliation: Medizinische Klinik III, Kardiologie und Kreislauferkrankungen, Universitaetsklinikum der Eberhard-Karls Universitaet, Tuebingen, Germany.
authors.forename: Karin A L
authors.initials: KA
authors.lastname: Mueller
authors.affiliation: Medizinische Klinik III, Kardiologie und Kreislauferkrankungen, Universitaetsklinikum der Eberhard-Karls Universitaet, Tuebingen, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Heck
authors.affiliation: Medizinische Klinik III, Kardiologie und Kreislauferkrankungen, Universitaetsklinikum der Eberhard-Karls Universitaet, Tuebingen, Germany.
authors.forename: David
authors.initials: D
authors.lastname: Heinzmann
authors.affiliation: Medizinische Klinik III, Kardiologie und Kreislauferkrankungen, Universitaetsklinikum der Eberhard-Karls Universitaet, Tuebingen, Germany.
authors.forename: Johannes
authors.initials: J
authors.lastname: Schwille
authors.affiliation: Abteilung für Molekulare Pathologie, Universitaetsklinikum der Eberhard-Karls Universitaet, Tuebingen, Germany.
authors.forename: Karin
authors.initials: K
authors.lastname: Klingel
authors.affiliation: Abteilung für Molekulare Pathologie, Universitaetsklinikum der Eberhard-Karls Universitaet, Tuebingen, Germany.
authors.forename: Reinhard
authors.initials: R
authors.lastname: Kandolf
authors.affiliation: Institut für Radiologie, Universitaetsklinikum der Eberhard-Karls Universitaet, Tuebingen, Germany.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Kramer
authors.affiliation: Medizinische Klinik III, Kardiologie und Kreislauferkrankungen, Universitaetsklinikum der Eberhard-Karls Universitaet, Tuebingen, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Gramlich
authors.affiliation: Medizinische Klinik III, Kardiologie und Kreislauferkrankungen, Universitaetsklinikum der Eberhard-Karls Universitaet, Tuebingen, Germany.
authors.forename: Tobias
authors.initials: T
authors.lastname: Geisler
authors.affiliation: Medizinische Klinik III, Kardiologie und Kreislauferkrankungen, Universitaetsklinikum der Eberhard-Karls Universitaet, Tuebingen, Germany.
authors.forename: Meinrad P
authors.initials: MP
authors.lastname: Gawaz
authors.affiliation: Medizinische Klinik III, Kardiologie und Kreislauferkrankungen, Universitaetsklinikum der Eberhard-Karls Universitaet, Tuebingen, Germany.
authors.forename: Juergen
authors.initials: J
authors.lastname: Schreieck
authors.affiliation: Medizinische Klinik III, Kardiologie und Kreislauferkrankungen, Universitaetsklinikum der Eberhard-Karls Universitaet, Tuebingen, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Seizer
mesh_terms: D000368:Aged; D015415:Biomarkers; D001706:Biopsy; D002311:Cardiomyopathy, Dilated / Q000473:pathology*; D005260:Female; D005682:Gadolinium / Q000008:administration & dosage*; D006352:Heart Ventricles / Q000473:pathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
chemical_list: D015415:Biomarkers; D005682:Gadolinium