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Prognostic value of myocardial fibrosis on cardiac magnetic resonance imaging in patients with ischemic cardiomyopathy: A systematic review. Am Heart J 2020; 229:52-60. [PMID: 32916608 PMCID: PMC7417269 DOI: 10.1016/j.ahj.2020.08.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Accepted: 08/03/2020] [Indexed: 01/15/2023]
Abstract
The use of cardiac magnetic resonance imaging (c-MRI) in risk stratification for clinical outcomes of patients with ischemic cardiomyopathy (ICM) remains low. This systematic review investigated the prognostic value of myocardial fibrosis as assessed by late gadolinium enhancement (LGE) on c-MRI in patients with ICM for ventricular tachyarrhythmia, sudden cardiac death (SCD), or all-cause mortality. Methods We conducted a systematic review of the electronic databases Pubmed and Embase for relevant prospective English-language studies published between January 1990 and February 2019. All included articles were prospective studies that comprised of human participants older than 18 years with ICM and a primary or secondary prevention implantable cardioverter/defibrillator (ICD); had a sample size >30 participants; had at least 6 months of follow-up; and reported on ventricular tachyarrhythmia, SCD, and all-cause mortality. A total of 90 articles related to ICM were identified and were subsequently screened independently by 2 authors. Pooled sensitivity and specificity of LGE were calculated using random-effects model. Results Eight studies with 1,085 participants were included in the final analysis. The mean age of patients varied from 43 to 83 years, with most patients being men. The most common comorbidities reported included history of diabetes mellitus (22%-62%), hyperlipidemia (40%-86%), and hypertension (35%-88%). The ejection fraction of each study was reported as mean or median and varied from 22% to 35%. During a follow-up that ranged from 8.5 to 65 months, there were 110 ventricular arrhythmic events reported. The pooled sensitivity and specificity of LGE for ICD therapy delivered for ventricular arrhythmias were 0.79 (95% CI: 0.66-0.87) and 0.28 (95% CI: 0.14-0.46), respectively. For all-cause mortality, the pooled sensitivity and specificity of LGE were 0.76 (95% CI: 0.40-0.93) and 0.41 (95% CI: 0.14-0.75), respectively. Although SCD was of significant interest to our review, only 1 of the studies reported on the association between LGE and SCD, leading to the subsequent exclusion of SCD from the end point analysis. Conclusions LGE has high prognostic value in predicting adverse outcomes in patients with ICM and may provide helpful information for clinical decision making related to SCD prevention. Our findings illustrate how LGE may improve current risk stratification, prognostication, and selection of patients with ICM for ICD therapy.
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Di Bella G, Pizzino F, Aquaro GD, Piaggi P, Venuti G, Carerj S, Pingitore A. High-risk patients with mild-moderate left ventricular dysfunction after a previous myocardial infarction. A long-term prognostic data by cardiac magnetic resonance. Int J Cardiol 2017; 245:13-19. [PMID: 28757089 DOI: 10.1016/j.ijcard.2017.07.064] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Revised: 07/15/2017] [Accepted: 07/18/2017] [Indexed: 12/28/2022]
Abstract
BACKGROUND Few studies have explored prognosis in patients with previous myocardial infarction (MI) with mild-moderate (MM) left ventricular (LV) dysfunction (D). The aim of our study was to investigate whether combining LV parameters obtained by cardiac magnetic resonance (CMR) improves risk stratification of patients with previous MI and MM-LV-D. METHODS In 418 consecutive patients (63.3±11.3years old, female 12.9%) with previous MI, we quantified LVEF, volumes and wall motion score index (WMSI) and measured the infarct extent by late gadolinium enhancement (LGE). According to LVEF, patients were considered with normal LVEF (>55%), MM-LV-D (LVEF>30 and ≤55%) and severe (S) LV-D (LVEF ≤30). RESULTS During follow-up (median, 39.7months) cardiac events (cardiac death or appropriate intra-cardiac defibrillator shocks) occurred in 17/99 of patients with S-LV-D, in 15/201 with MM-LV-D, and in only 1/118 of those with normal LV-EF. After adjustment for age, an extent of LGE >11.3%, a dilated LV (male >112ml/m2; female >92ml/m2) and a WMSI>1.59 were associated with adverse cardiac events in patients with MM-LV-D. In patients with MM-LV-D, when each of these 3 factors was observed, the prognosis was worse respect to those with 1-2 factors and no factor (p=0.035 and p=0.004, respectively). Prognosis was similar (p=0.61) between MM-LV-D patients with all 3 factors and those with S-LV-dysfunction. CONCLUSIONS A multiparametric CMR approach, which includes LGE, dilated LV and WMSI, permits to identify post MI patients with MM-LV-D with a risk of cardiac events similar to those with S-LV-D. Further multicenter studies are needed to confirm our data.
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Affiliation(s)
- Gianluca Di Bella
- CNR Institute of Clinical Physiology, Pisa, Italy; Clinical and Experimental Department of Medicine and Pharmacology, University of Messina, Messina, Italy.
| | - Fausto Pizzino
- Fondazione Toscana G. Monasterio, CNR, Regione Toscana, Pisa, Italy; Clinical and Experimental Department of Medicine and Pharmacology, University of Messina, Messina, Italy
| | - Giovanni Donato Aquaro
- Clinical and Experimental Department of Medicine and Pharmacology, University of Messina, Messina, Italy
| | - Paolo Piaggi
- Department of Clinical and Experimental Medicine, Section of Endocrinology, University of Pisa, Pisa, Italy
| | - Giuseppe Venuti
- Clinical and Experimental Department of Medicine and Pharmacology, University of Messina, Messina, Italy
| | - Scipione Carerj
- Clinical and Experimental Department of Medicine and Pharmacology, University of Messina, Messina, Italy
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Zeidan-Shwiri T, Yang Y, Lashevsky I, Kadmon E, Kagal D, Dick A, Laish Farkash A, Paul G, Gao D, Shurrab M, Newman D, Wright G, Crystal E. Magnetic resonance estimates of the extent and heterogeneity of scar tissue in ICD patients with ischemic cardiomyopathy predict ventricular arrhythmia. Heart Rhythm 2015; 12:802-8. [PMID: 25583153 DOI: 10.1016/j.hrthm.2015.01.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2014] [Indexed: 12/30/2022]
Abstract
BACKGROUND The majority of patients receiving implantable cardioverter-defibrillator (ICD) implantation under current guidelines never develop sustained ventricular arrhythmia; therefore, better markers of risk for sustained ventricular tachycardia and/or ventricular fibrillation are needed. OBJECTIVE The purpose of this study was to identify cardiac magnetic resonance arrhythmic risk predictors of ischemic cardiomyopathy before ICD implantation. METHODS Forty-three subjects (mean age, 64.5 ± 11.9 years) with previous myocardial infarction who were referred for ICD implantation were evaluated by cardiac magnetic resonance imaging (MRI). The MRI protocol included left ventricular functional parameter assessment using steady-state free precession and late gadolinium enhancement MRI using inversion recovery fast gradient echo. Left ventricular functional parameters were measured using cardiac magnetic resonance software. Subjects were followed up for 6-46 months, and the events of appropriate ICD treatments (shocks and antitachycardia pacing) were recorded. RESULTS Twenty-eight patients experienced 46 spontaneous episodes during a median follow-up duration of 30 months. The total myocardial infarct (MI) size (18.05 ± 11.44 g vs 38.83 ± 19.87 g; P = .0006), MI core (11.63 ± 7.14 g vs 24.12 ± 12.73 g; P = .0002), and infarct gray zone (6.43 ± 4.64 g vs 14.71 ± 7.65 g; P = .0004) were significantly larger in subjects who received appropriate ICD therapy than in those who did not experience an episode of ventricular tachycardia and/or ventricular fibrillation. Multivariate regression analyses for the infarct gray zone and MI core adjusted for New York Heart Association class, diabetes, and etiology (primary or secondary prevention) revealed that the gray zone and MI core were predictors of appropriate ICD therapies (P = .0018 and P = .007, respectively). CONCLUSION The extent of MI scar may predict which patients would benefit most from ICD implantation.
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Affiliation(s)
- Tawfiq Zeidan-Shwiri
- Arrhythmia Services, Schulich Heart Centre, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada.
| | - Yuesong Yang
- Arrhythmia Services, Schulich Heart Centre, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Ilan Lashevsky
- Arrhythmia Services, Schulich Heart Centre, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Ehud Kadmon
- Arrhythmia Services, Schulich Heart Centre, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Darren Kagal
- Arrhythmia Services, Schulich Heart Centre, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Alexander Dick
- Arrhythmia Services, Schulich Heart Centre, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Avishag Laish Farkash
- Arrhythmia Services, Schulich Heart Centre, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Gideon Paul
- Arrhythmia Services, Schulich Heart Centre, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Donsheng Gao
- Arrhythmia Services, Schulich Heart Centre, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Mohammed Shurrab
- Arrhythmia Services, Schulich Heart Centre, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - David Newman
- Arrhythmia Services, Schulich Heart Centre, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Graham Wright
- Arrhythmia Services, Schulich Heart Centre, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Eugene Crystal
- Arrhythmia Services, Schulich Heart Centre, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
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Mordi I, Jhund PS, Gardner RS, Payne J, Carrick D, Berry C, Tzemos N. LGE and NT-proBNP Identify Low Risk of Death or Arrhythmic Events in Patients With Primary Prevention ICDs. JACC Cardiovasc Imaging 2014; 7:561-9. [DOI: 10.1016/j.jcmg.2013.12.014] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Revised: 12/18/2013] [Accepted: 12/26/2013] [Indexed: 11/16/2022]
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Conductive Channels Identified With Contrast-Enhanced MR Imaging Predict Ventricular Tachycardia in Systolic Heart Failure. JACC Cardiovasc Imaging 2013; 6:1152-9. [DOI: 10.1016/j.jcmg.2013.05.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2012] [Revised: 05/03/2013] [Accepted: 05/06/2013] [Indexed: 11/18/2022]
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Yang Y, Connelly KA, Zeidan-Shwiri T, Lu Y, Paul G, Roifman I, Zia MI, Graham JJ, Dick AJ, Crystal E, Wright GA. Multi-contrast late enhancement CMR determined gray zone and papillary muscle involvement predict appropriate ICD therapy in patients with ischemic heart disease. J Cardiovasc Magn Reson 2013; 15:57. [PMID: 23803259 PMCID: PMC3702486 DOI: 10.1186/1532-429x-15-57] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Accepted: 06/13/2013] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Myocardial infarct heterogeneity indices including peri-infarct gray zone are predictors for spontaneous ventricular arrhythmias events after ICD implantation in patients with ischemic heart disease. In this study we hypothesize that the extent of peri-infarct gray zone and papillary muscle infarct scores determined by a new multi-contrast late enhancement (MCLE) method may predict appropriate ICD therapy in patients with ischemic heart disease. METHODS The cardiovascular magnetic resonance (CMR) protocol included LV functional parameter assessment and late gadolinium enhancement (LGE) CMR using the conventional method and MCLE post-contrast. The proportion of peri-infarct gray zone, core infarct, total infarct relative to LV myocardium mass, papillary muscle infarct scores, and LV functional parameters were statistically compared between groups with and without appropriate ICD therapy during follow-up. RESULTS Twenty-five patients with prior myocardial infarct for planned ICD implantation (age 64±10 yrs, 88% men, average LVEF 26.2±10.4%) were enrolled. All patients completed the CMR protocol and 6-46 months follow-up at the ICD clinic. Twelve patients had at least one appropriate ICD therapy for ventricular arrhythmias at follow-up. Only the proportion of gray zone measured with MCLE and papillary muscle infarct scores demonstrated a statistically significant difference (P < 0.05) between patients with and without appropriate ICD therapy for ventricular arrhythmias; other CMR derived parameters such as LVEF, core infarct and total infarct did not show a statistically significant difference between these two groups. CONCLUSIONS Peri-infarct gray zone measurement using MCLE, compared to using conventional LGE-CMR, might be more sensitive in predicting appropriate ICD therapy for ventricular arrhythmia events. Papillary muscle infarct scores might have a specific role for predicting appropriate ICD therapy although the exact mechanism needs further investigation.
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Affiliation(s)
- Yuesong Yang
- Imaging Research and Schulich Heart Center, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, Ontario, Canada
| | - Kim A Connelly
- Division of Cardiology and Keenan Research Centre in the Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 30 Bond Street, Toronto, Ontario, Canada
| | - Tawfiq Zeidan-Shwiri
- Imaging Research and Schulich Heart Center, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, Ontario, Canada
| | - Yingli Lu
- Imaging Research and Schulich Heart Center, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, Ontario, Canada
| | - Gideon Paul
- Imaging Research and Schulich Heart Center, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, Ontario, Canada
| | - Idan Roifman
- Imaging Research and Schulich Heart Center, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, Ontario, Canada
| | - Mohammad I Zia
- Imaging Research and Schulich Heart Center, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, Ontario, Canada
| | - John J Graham
- Division of Cardiology and Keenan Research Centre in the Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 30 Bond Street, Toronto, Ontario, Canada
| | - Alexander J Dick
- Ottawa Heart Institute, 42 Ruskin Street, Ottawa, Ontario, Canada
| | - Eugene Crystal
- Imaging Research and Schulich Heart Center, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, Ontario, Canada
| | - Graham A Wright
- Imaging Research and Schulich Heart Center, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, Ontario, Canada
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Scott PA, Rosengarten JA, Curzen NP, Morgan JM. Late gadolinium enhancement cardiac magnetic resonance imaging for the prediction of ventricular tachyarrhythmic events: a meta-analysis. Eur J Heart Fail 2013; 15:1019-27. [PMID: 23558217 DOI: 10.1093/eurjhf/hft053] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
AIMS Approaches to the risk stratification for sudden cardiac death (SCD) remain unsatisfactory. Although late gadolinium enhancement cardiac magnetic resonance imaging (LGE-CMR) for SCD risk stratification has been evaluated in several studies, small sample size has limited their clinical validity. We performed this meta-analysis to better gauge the predictive accuracy of LGE-CMR for SCD risk stratification. METHODS AND RESULTS Electronic databases and published bibliographies were systematically searched to identify studies evaluating the association between the extent of LV scar on LGE-CMR and ventricular arrhythmic events [SCD, resuscitated cardiac arrest, the occurrence of ventricular arrhythmias, or appropriate implantable cardioverter defibrillator (ICD) therapy]. Only studies enrolling patients with CAD or non-ischaemic cardiomyopathy were included. Summary estimates of the relative risk (RR) and likelihood ratios (LRs) were calculated using random effects models. Eleven studies comprising 1105 patients were identified. During a mean/median follow-up of 8.5-41 months 207 patients had ventricular arrhythmic events. Ventricular arrhythmic events were more common in patients with a greater extent of LV scar: RR 4.33 [95% confidence interval (CI) 2.98-6.29], positive LR 1.98 (95% CI 1.66-2.37), and negative LR 0.33 (95% CI 0.24-0.46). CONCLUSION The extent of LGE on CMR is strongly associated with the occurrence of ventricular arrhythmias in patients with reduced LVEF and may be a valuable risk stratification tool for identifying patients who will benefit from ICD therapy. However, uncertainties regarding clinical application persist and need to be addressed prior to introduction into broad clinical practice.
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Affiliation(s)
- Paul A Scott
- Wessex Cardiothoracic Unit, University Hospital Southampton NHS Foundation Trust, UK.
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Alexandre J, Saloux E, Dugué AE, Lebon A, Lemaitre A, Roule V, Labombarda F, Provost N, Gomes S, Scanu P, Milliez P. Scar extent evaluated by late gadolinium enhancement CMR: a powerful predictor of long term appropriate ICD therapy in patients with coronary artery disease. J Cardiovasc Magn Reson 2013; 15:12. [PMID: 23331500 PMCID: PMC3610203 DOI: 10.1186/1532-429x-15-12] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2012] [Accepted: 01/03/2013] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Coronary artery disease (CAD) patients are at risk for life-threatening ventricular arrhythmias (VA) related to scar tissue. Late gadolinium enhancement cardiovascular magnetic resonance (LGE-CMR) can accurately identify myocardial scar extent. It has been shown that scar extent, particularly scar transmurality, percent scar and scar mass, are associated with the occurrence of appropriate implantable cardioverter-defibrillator (ICD) therapy. However, quantification of transmurality extent has never been studied. The purpose of our study was to evaluate whether different methods quantifying scar transmurality, percent scar and scar mass (assessed with LGE-CMR) can predict appropriate ICD therapy in CAD patients with a long term follow-up period. METHODS AND RESULTS We enrolled retrospectively 66 patients with chronic CAD referred for primary or secondary preventive ICD implantation and LGE-CMR before ICD implantation. Using LGE-CMR, scar extent was assessed by measuring scar mass, percent scar and transmural scar extent using four different methods. The median follow-up duration was 41.5 months (interquartile range 22-52). The endpoint was the occurrence of appropriate device therapy and occurred in 14 patients. Pre-ICD revascularization and transmural scar extent were significantly associated with the study endpoint but the latter was especially highly dependent on the method used. Patients with appropriate device therapy had also larger scar mass (29.6 ± 14.5 g vs 17.1 ± 8.8 g, p = 0.004), and larger percent scar (15.1 ± 8.2% vs 9.9 ± 5.6%, p = 0.03) than patients without appropriate device therapy. In multivariate analysis, scar extent variables remained significantly associated with the study end-point. CONCLUSIONS In this study of CAD patients implanted for primary or secondary preventive ICD, pre-ICD revascularization and scar extent studied by LGE-CMR were significantly associated with appropriate device therapy and can identify a subgroup of CAD patients with an increased risk of life-threatening VA. Depending of the method used, transmural scar extent may vary significantly and needs further studies to obtain a validated and consensual study method.
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Affiliation(s)
- Joachim Alexandre
- Department of cardiology, CHU de Caen, Avenue de la Côte de Nacre, F-14000, Caen, France
| | - Eric Saloux
- Department of cardiology, CHU de Caen, Avenue de la Côte de Nacre, F-14000, Caen, France
- Université de Caen Basse-Normandie, Medical School, F-14000, Caen, France
| | - Audrey Emmanuelle Dugué
- Department of biostatistics and clinical research, CHU de Caen, F-14000, Caen, France
- Université de Caen Basse-Normandie, Medical School, F-14000, Caen, France
| | - Alain Lebon
- Department of cardiology, CHU de Caen, Avenue de la Côte de Nacre, F-14000, Caen, France
- Université de Caen Basse-Normandie, Medical School, F-14000, Caen, France
| | - Adrien Lemaitre
- Department of cardiology, CHU de Caen, Avenue de la Côte de Nacre, F-14000, Caen, France
| | - Vincent Roule
- Department of cardiology, CHU de Caen, Avenue de la Côte de Nacre, F-14000, Caen, France
- Université de Caen Basse-Normandie, Medical School, F-14000, Caen, France
| | - Fabien Labombarda
- Department of cardiology, CHU de Caen, Avenue de la Côte de Nacre, F-14000, Caen, France
| | - Nicole Provost
- Department of radiology, CHU de Caen, F-14000, Caen, France
| | - Sophie Gomes
- Department of cardiology, CHU de Caen, Avenue de la Côte de Nacre, F-14000, Caen, France
| | - Patrice Scanu
- Department of cardiology, CHU de Caen, Avenue de la Côte de Nacre, F-14000, Caen, France
| | - Paul Milliez
- Department of cardiology, CHU de Caen, Avenue de la Côte de Nacre, F-14000, Caen, France
- Université de Caen Basse-Normandie, Medical School, F-14000, Caen, France
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Bibliography. Cardiovascular medicine (CM). Current world literature. Curr Opin Pediatr 2012; 24:656-60. [PMID: 22954957 DOI: 10.1097/mop.0b013e328358bc78] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Ng J, Jacobson JT, Ng JK, Gordon D, Lee DC, Carr JC, Goldberger JJ. Virtual electrophysiological study in a 3-dimensional cardiac magnetic resonance imaging model of porcine myocardial infarction. J Am Coll Cardiol 2012; 60:423-30. [PMID: 22633654 DOI: 10.1016/j.jacc.2012.03.029] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2012] [Revised: 02/23/2012] [Accepted: 03/12/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVES This study sought to test the hypothesis that "virtual" electrophysiological studies (EPS) on an anatomic platform generated by 3-dimensional magnetic resonance imaging reconstruction of the left ventricle can reproduce the reentrant circuits of induced ventricular tachycardia (VT) in a porcine model of myocardial infarction. BACKGROUND Delayed-enhancement magnetic resonance imaging has been used to characterize myocardial infarction and "gray zones," which are thought to reflect heterogeneous regions of viable and nonviable myocytes. METHODS Myocardial infarction by coronary artery occlusion was induced in 8 pigs. After a recovery period, 3-dimensional cardiac magnetic resonance images were obtained from each pig in vivo. Normal areas, gray zones, and infarct cores were classified based on voxel intensity. In the computer model, gray zones were assigned slower conduction and longer action potential durations than those for normal myocardium. Virtual EPS was performed and compared with results of actual in vivo programmed stimulation and noncontact mapping. RESULTS The left ventricular volumes ranged from 97.8 to 166.2 cm(3), with 4.9% to 17.5% of voxels classified as infarct zones. Six of the 7 pigs in which VT developed during actual EPS were also inducible with virtual EPS. Four of the 6 pigs that had simulated VT had reentrant circuits that approximated the circuits seen with noncontact mapping, whereas the remaining 2 had similar circuits but propagating in opposite directions. CONCLUSIONS This initial study demonstrates the feasibility of applying a mathematical model to magnetic resonance imaging reconstructions of the left ventricle to predict VT circuits. Virtual EPS may be helpful to plan catheter ablation strategies or to identify patients who are at risk of future episodes of VT.
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Affiliation(s)
- Jason Ng
- Division of Cardiology and Bluhm Cardiovascular Institute, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
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Cardiovascular imaging 2011 in the International Journal of Cardiovascular Imaging. Int J Cardiovasc Imaging 2012; 28:439-51. [PMID: 22476909 PMCID: PMC3326368 DOI: 10.1007/s10554-012-0040-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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van der Wall EE, Zeppenfeld K, Bax JJ, Siebelink HM, Schalij MJ. CMR-determined scar volume: predictive for ventricular tachycardias? Int J Cardiovasc Imaging 2010; 27:989-93. [PMID: 21061171 PMCID: PMC3182320 DOI: 10.1007/s10554-010-9744-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2010] [Accepted: 10/27/2010] [Indexed: 11/30/2022]
Abstract
The interesting data reported by Bernhardt et al. strengthen the diagnostic benefit of CMR in patients with ischemic cardiomyopathy. Consequently, the presence, location and size of the CMR-determined scar tissue may be used for better risk stratification in patients with ischemic cardiomyopathy eligible for ICD therapy.
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Affiliation(s)
- E. E. van der Wall
- Department of Cardiology, Leiden University Medical Center, P.O. Box 9600, Leiden, Netherlands
| | - K. Zeppenfeld
- Department of Cardiology, Leiden University Medical Center, P.O. Box 9600, Leiden, Netherlands
| | - J. J. Bax
- Department of Cardiology, Leiden University Medical Center, P.O. Box 9600, Leiden, Netherlands
| | - H. M. Siebelink
- Department of Cardiology, Leiden University Medical Center, P.O. Box 9600, Leiden, Netherlands
| | - M. J. Schalij
- Department of Cardiology, Leiden University Medical Center, P.O. Box 9600, Leiden, Netherlands
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