Impact of late gadolinium enhancement extent, location, and pattern on ventricular tachycardia and major adverse cardiac events in patients with ischemic vs. non-ischemic cardiomyopathy

Tat, Emily; Ball, Caroline; Camren, Gerald P.; Wroblewski, Igor; Dajani, Khaled A.; Goldberg, Allen I.; Kinno, Menhel; Sanagala, Thriveni; Syed, Mushabbar A.; Wilber, David J.; Rabbat, Mark

doi:10.3389/fcvm.2022.1026215

Cited by 10 publications

(5 citation statements)

References 36 publications

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“…Although patients with normal LV function are at significantly lower risk for adverse events, a certain proportion of these patients still develops heart failure, ventricular tachycardia, or recurrent myocarditis at follow-up, underlying the need for better risk stratification in this subgroup. Impairment of septal RLS was associated with outcomes in this patient population, which is in line with previous studies, that identified septal involvement by LGE as a high-risk feature in myocarditis [ 7 , 19 ] or ischemic heart disease [ 24 ]. Septal involvement might indicate extending of inflammation to the right ventricle or can go along with involvement of the conduction system, both of which are associated with poor outcomes [ 8 , 25 – 27 ].…”

Section: Discussionsupporting

confidence: 91%

Prognostic value of visual and quantitative CMR regional myocardial function in patients with suspected myocarditis

Bernhard,

Joss,

Greisser

et al. 2024

Int J Cardiovasc Imaging

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According to updated Lake-Louise Criteria, impaired regional myocardial function serves as a supportive criterion in diagnosing myocarditis. This study aimed to assess visual regional wall motional abnormalities (RWMA) and novel quantitative regional longitudinal peak strain (RLS) for risk stratification in the clinical setting of myocarditis. In patients undergoing CMR and meeting clinical criteria for suspected myocarditis global longitudinal strain (GLS), late gadolinium enhancement (LGE), RWMA and RLS were assessed in the anterior, septal, inferior, and lateral regions and correlated to the occurrence of major adverse cardiac events (MACE), including heart failure hospitalization, sustained ventricular tachycardia, recurrent myocarditis, and all-cause death. In 690 consecutive patients (age: 48.0 ± 16.0 years; 37.7% female) with suspected myocarditis impaired RLS was correlated with RWMA and LV-GLS but not with the presence of LGE. At median follow up of 3.8 years, MACE occurred in 116 (16.8%) patients. Both, RWMA and RLS in anterior-, septal-, inferior-, and lateral- locations were univariately associated with outcomes (all p < 0.001), but not after adjusting for clinical characteristics and LV-GLS. In the subgroup of patients with normal LV function, RWMA were not predictive of outcomes, whereas septal RLS had incremental and independent prognostic value over clinical characteristics (HRadjusted = 1.132, 95% CI 1.020–1.256; p = 0.020). RWMA and RLS can be used to assess regional impairment of myocardial function in myocarditis but are of limited prognostic value in the overall population. However, in the subgroup of patients with normal LV function, septal RLS represents a distinctive marker of regional LV dysfunction, offering potential for risk-stratification. Graphical abstract CI: confidence interval, CMR: cardiac magnetic resonance imaging, HR: hazard ratio, MACE major adverse cardiovascular events

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Section: Discussionsupporting

confidence: 91%

Prognostic value of visual and quantitative CMR regional myocardial function in patients with suspected myocarditis

Bernhard,

Joss,

Greisser

et al. 2024

Int J Cardiovasc Imaging

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“…CMR can be useful to assess the arrhythmic risk and to predict adverse outcomes in patients with ALVC [35]. A diffuse LGE at CRM is correlated with a high risk of life-threatening ventricular arrhythmias [36] and it is considered a marker of SCD risk in patients with left ventricle ejection fraction (LVEF) between 35% and 50% [11,[37][38][39][40]. Autoptic studies confirmed signs of inflammation in 60-80% of ACM cases [41].…”

Section: Cardiac Magnetic Resonancementioning

confidence: 99%

Arrhythmogenic Left Ventricular Cardiomyopathy: From Diagnosis to Risk Management

Mauriello,

Roma,

Ascrizzi

et al. 2024

JCM

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Purpose of Review: Left ventricular arrhythmogenic cardiomyopathy (ALVC) is a rare and poorly characterized cardiomyopathy that has recently been reclassified in the group of non-dilated left ventricular cardiomyopathies. This review aims to summarize the background, diagnosis, and sudden cardiac death risk in patients presenting this cardiomyopathy. Recent Findings: Although there is currently a lack of data on this condition, arrhythmogenic left ventricular dysplasia can be considered a specific disease of the left ventricle (LV). We have collected the latest evidence about the management and the risks associated with this cardiomyopathy. Summary: Left ventricular arrhythmogenic cardiomyopathy is still poorly characterized. ALVC is characterized by fibrofatty replacement in the left ventricular myocardium, with variable phenotypic expression. Diagnosis is based on a multiparametric approach, including cardiac magnetic resonance (CMR) and genetic testing, and is important for sudden cardiac death (SCD) risk stratification and management. Recent guidelines have improved the management of left ventricular arrhythmogenic cardiomyopathy. Further studies are necessary to improve knowledge of this cardiomyopathy.

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“…В настоящее время не существует золотого стандарта количественной оценки ПНГ в миокарде. Предпочтение метода количественной оценки различается в зависимости от заболевания миокарда: FWHM часто используется для ИКМ, а метод порогового значения SD часто используется для НИКМП [13][14][15][16]. В работе для количественной оценки ПНГ мы использовали метод FWHM.…”

Section: обсуждение полученных результатовunclassified

“…В другом исследовании у больных ИКМП наличие ПНГ в межжелудочковой перегородке было самым сильным предиктором ЖА и больших кардиальных событий (МАСЕ), авторы объясняют это вовлечением в процесс проводящей системы. Локализация ПНГ на передней стенке была самым значимым предиктором желудочковых аритмий [16]. Различия могут быть объяснены тем, что в первом исследовании изучались пациенты НИКМП, имеющие принципиально другие механизмы образования рубцовой ткани, а во втором исследовании имелись различия в отношении конечных точек, так в настоящем исследовании оценивались обоснованные срабатывания и общая летальность, а в исследовании коллег фиксировались как устойчивые, так и неустойчивые желудочковые тахикардии и перечень крупных кардиальных событий.…”

Section: обсуждение полученных результатовunclassified

Prognostic value of delayed gadolinium enhancement on cardiac magnetic resonance imaging in patients with ischemic cardiomyopathy and an implanted cardioverter-defibrillator

Bazylev,

Ushakov,

Durmanov

et al. 2024

Vestnik aritmologii

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Aim. To examine the impact of late gadolinium enhancement (LGE) in the left ventricular myocardium on magnetic resonance imaging (MRI) on overall mortality and the phases of arrhythmic events in patients with ischemic cardiomyopathy and implantable cardioverter defibrillator (ICD).Methods. This was a single-center retrospective study. A total of 382 medical records of patients from the period between 2019 and 2022, who underwent ICD implantation as part of primary prevention of sudden cardiac death at National Centre of Cardiovascular Surgery, were analyzed. Seventy-four patients were selected for the study. Observation was conducted through in-person examinations and remote monitoring. Endpoints evaluated included overall mortality and arrhythmic events. The cause of death was determined based on the “Promed” medical database. Patients who reached a specific endpoint constituted the case group, while those who did not reach any endpoint formed the control group.Results. During the observation period, arrhythmic events were registered in 26 patients (35.1%), with a total of 27.1±13.2 events. Twenty-one patients (28.4%) deceased. In univariate regression analysis, the presence of LGE, the extent of LGE (%), and the number of segments with LGE served as predictors of ICD activation and overall mortality. Two multivariate logistic regression models were constructed. ROC curves were used to determine the quality of the regression model, with an area under the curve of 0.807 for ICD activation and 0.789 for mortality. The highest sensitivity and specificity of the method were observed with a LGE value equal to or greater than 14% for ICD activation (sensitivity 81%, specificity 75%) and 26% for overall mortality (sensitivity 89%, specificity 64%).Conclusion. Substantiated ICD activations (shock/antitachycardia pacing) were observed in 35.1% of cases, and the overall mortality rate was 28.4%. The association between ICD activation and the extent of LGE occurred when LGE was >14%. The association between overall mortality and the extent of LGE occurred when LGE was >26%.

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Impact of late gadolinium enhancement extent, location, and pattern on ventricular tachycardia and major adverse cardiac events in patients with ischemic vs. non-ischemic cardiomyopathy

Cited by 10 publications

References 36 publications

Prognostic value of visual and quantitative CMR regional myocardial function in patients with suspected myocarditis

Prognostic value of visual and quantitative CMR regional myocardial function in patients with suspected myocarditis

Arrhythmogenic Left Ventricular Cardiomyopathy: From Diagnosis to Risk Management

Prognostic value of delayed gadolinium enhancement on cardiac magnetic resonance imaging in patients with ischemic cardiomyopathy and an implanted cardioverter-defibrillator

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