Late gadolinium enhancement on cardiac magnetic resonance represents the depolarizing and repolarizing electrically damaged foci causing malignant ventricular arrhythmia in hypertrophic cardiomyopathy

Naka, Sadahiro; Kawamura, Y.; Sato, Nobuyuki; Nimura, Asami; Matsuki, Motoki; Yamauchi, Atsushi; Kanno, Takayasu; Tanabe, Yasuko; Takeuchi, Toshiharu; Natori, Shunsuke; Saijo, Yasuaki; Aburano, Tamio; Hasebe, Naoyuki

doi:10.1016/j.hrthm.2015.02.004

Cited by 24 publications

(16 citation statements)

References 25 publications

(22 reference statements)

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“…Areas of LGE in patients with HCM were previously shown to exhibit both depolarization and repolarization abnormalities when assessed by electrophysiology studies, which may trigger malignant ventricular arrhythmia. Moreover, all the observed VT originated from myocardium exhibiting LGE on CMR . In HCM patients with an ICD, monomorphic VT is the predominant ventricular arrhythmia, consistent with scar‐related arrhythmia .…”

Section: Discussionmentioning

confidence: 74%

“…Some of these studies have demonstrated an association between the extent of LGE and presence of NSVT, whereas others have found an association between the presence rather than the extent of LGE and NSVT . Furthermore, other studies have found a correlation between the extent of LGE and inducible ventricular tachycardia (VT) and the origin of ventricular arrhythmia to be within the myocardium exhibiting LGE . Despite the lack of strong evidence, a higher burden of NSVT as well as more prolonged and faster runs of NSVT are considered by many clinicians to be a marker of greater arrhythmia risk.…”

Section: Introductionmentioning

confidence: 99%

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The relationship between the quantitative extent of late gadolinium enhancement and burden of nonsustained ventricular tachycardia in hypertrophic cardiomyopathy: A delayed contrast‐enhanced magnetic resonance study

Weissler‐Snir

Hindieh

Spears

et al. 2019

Cardiovasc electrophysiol

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Objectives To examine the relationship between late gadolinium enhancement (LGE) extent and nonsustained ventricular tachycardia (NSVT) characteristics in patients with hypertrophic cardiomyopathy (HCM). Background NSVT has been shown to be independently associated with sudden cardiac death (SCD) in HCM. Previous studies have found LGE on cardiac magnetic resonance (CMR) to be independently associated with NSVT. Methods Seventy‐three patients who had 14‐day Holter monitoring for either risk stratification for SCD (n = 62) or evaluation of atrial fibrillation (n = 11) on a CMR study were included. Areas of LGE in left ventricle (LV) were visually identified and analyzed quantitatively for both high (≥6 SD above the mean signal intensity of normal myocardium) and intermediate (≥4 but <6 SD) LGE signal intensity. Results Patients with more extensive LGE had longer (P = 0.0028) and more frequent (P = 0.02) episodes of NSVT. In univariate analyses, frequency of NSVT was associated with LGE extent (rs = 0.43, P = 0.001), LV ejection fraction (rs = −0.38, P < 0.001), LV mass (rs = 0.32, P = 0.005), LV maximal wall thickness (rs = 0.28, P = 0.016), and left atrium diameter (rs = 0.29, P = 0.001); maximal length of NSVT was associated with LGE extent (rs = 0.52, P < 0.001), LV ejection fraction (rs = −0.44, P < 0.001), LV mass (rs = 0.37, P = 0.001), and left atrium diameter (rs = 0.3, P < 0.001). In multivariable analyses, LGE extent remained the sole variable independently associated with frequency (P = 0.001) and maximal length of episodes of NSVT (P = 0.001). No significant association was found between the rate of NSVT and LGE extent. Conclusions LGE extent is independently associated with a greater burden and longer episodes of NSVT in HCM. These findings support the association between myocardial fibrosis as represented by LGE and ventricular tachyarrhythmias in HCM.

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Section: Discussionmentioning

confidence: 74%

Section: Introductionmentioning

confidence: 99%

The relationship between the quantitative extent of late gadolinium enhancement and burden of nonsustained ventricular tachycardia in hypertrophic cardiomyopathy: A delayed contrast‐enhanced magnetic resonance study

Weissler‐Snir

Hindieh

Spears

et al. 2019

Cardiovasc electrophysiol

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“…Ventricular arrhythmias represent the most likely mechanism of SCD in HCM and originate from regions of structurally abnormal myocardium. The extension of localized LGE significantly correlates with both the corresponding depolarizing and repolarizing electrical damage causing ventricular arrhythmias in HCM . Although prospective outcome studies have demonstrated an association between the presence of LGE and a combined endpoint of adverse HCM‐related events, these studies have conflicting results regarding the relation between LGE and SCD.…”

Section: Discussionmentioning

confidence: 99%

“…[8][9][10] Although the presence of LGE in HCM has been associated with ventricular arrhythmias, the association with SCD has been largely questioned. [11][12][13][14][15][16][17][18][19] Initial research in this scenario considered LGE as a binary variable attributing equal risk to any amount of LGE, from trivial to extensive. In a disease in which the prevalence of LGE oscillates between 60% and 80%, this objective has proved impractical and nonrealistic.…”

mentioning

confidence: 99%

ESC sudden‐death risk model in hypertrophic cardiomyopathy: Incremental value of quantitative contrast‐enhanced CMR in intermediate‐risk patients

Hinojar

Zamorano

Gómez

et al. 2017

Clinical Cardiology

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Background Hypertrophic cardiomyopathy (HCM) remains the most common cause of sudden cardiac death (SCD) in the young; however, current strategies do not identify all HCM patients at risk. A novel validated algorithm was proposed by the last European Society of Cardiology guidelines to guide implantable cardioverter‐defibrillator (ICD) therapy. Recently, extensive myocardial fibrosis was independently associated with increased risk of SCD events. This study aimed to establish the relation between myocardial fibrosis (late gadolinium enhancement [LGE] extension) and the novel SCD risk‐prediction model in a real population of HCM to evaluate its potential additional value in the different risk groups. Hypothesis There is a significant association between LGE extension and the novel SCD risk calculator that may help conflicting ICD decisions. Methods Seventy‐seven patients with HCM underwent routine clinical evaluation, echocardiography, and cardiac magnetic resonance study. Their SCD risk at 5 years was calculated using the new model. Results Extension of LGE positively correlated with SCD risk prediction (r = 0.7, P < 0.001). Low‐, intermediate‐, and high‐risk groups according to the model showed significantly different extent of LGE (5% ± 6% vs 18% ± 9% vs 17% ± 4%; P < 0.001). Four patients (6%) in the low‐risk group and 5 (62%) in the intermediate‐risk group showed extensive areas of LGE. All patients except 1 (86%) at highest risk (n = 6) showed extensive areas of LGE. Conclusions LGE extension is concordant with the novel SCD‐risk model defining low‐ and high‐risk groups; it may provide additional information, allowing better discrimination to support implantable cardioverter‐defibrillator decision. LGE quantification holds promise for SCD stratification in HCM.

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“…1,5 Nonetheless, evidence of regional voltage variation, increased latency, and delayed conduction has been consistently observed. 30,31 In addition, the feasibility of invasive assessment of electrograms with the aim of addressing the functional significance of myofibrillar disarray without arrhythmia induction has been reported. 14 The capacity of such approaches to enhance risk prediction was strongly supported in a prospective study of 179 patients followed up over 4 years.…”

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confidence: 99%

Prophylactic Implantable Defibrillators for Hypertrophic Cardiomyopathy

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2015

Circ: Arrhythmia and Electrophysiology

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Late gadolinium enhancement on cardiac magnetic resonance represents the depolarizing and repolarizing electrically damaged foci causing malignant ventricular arrhythmia in hypertrophic cardiomyopathy

Cited by 24 publications

References 25 publications

The relationship between the quantitative extent of late gadolinium enhancement and burden of nonsustained ventricular tachycardia in hypertrophic cardiomyopathy: A delayed contrast‐enhanced magnetic resonance study

The relationship between the quantitative extent of late gadolinium enhancement and burden of nonsustained ventricular tachycardia in hypertrophic cardiomyopathy: A delayed contrast‐enhanced magnetic resonance study

ESC sudden‐death risk model in hypertrophic cardiomyopathy: Incremental value of quantitative contrast‐enhanced CMR in intermediate‐risk patients

Prophylactic Implantable Defibrillators for Hypertrophic Cardiomyopathy

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