Onassis Cardiac Surgery Center, 50 Esperou Street, P. Faliro, Athens 175-61 Greece.
Eur Heart J Cardiovasc Imaging. 2013 Jun;14(6):518-25. doi: 10.1093/ehjci/jes302. Epub 2013 Jan 16.
Ventricular tachycardia (VT) is the commonest cause of sudden cardiac death (SCD) in developed countries. Coronary artery disease (CAD) is the most frequent cause of VT in individuals over the age of 30, while hypertrophic cardiomyopathy (HCM), myocarditis and congenital heart disease in those below 30 years of age. Cardiac magnetic resonance (CMR), a non-invasive, non-radiating technique, can reliably detect the changes in ventricular volumes and the ejection fraction that can be predictive of VT/SCD. Furthermore, the capability of CMR to perform tissue characterization and detect oedema, fat and fibrotic substrate, using late gadolinium enhanced images (LGE), can predict VT/SCD in both ischaemic and non-ischaemic cardiomyopathy. The extent of LGE in HCM is correlated with risk factors of SCD and the likelihood of inducible VT. In idiopathic-dilated cardiomyopathy, the presence of midwall fibrosis, assessed by CMR, also predicts SCD/VT. Additionally, in arrhythmogenic right ventricle (RV) dysplasia/cardiomyopathy, CMR has an excellent correlation with histopathology and predicted inducible VT on programmed electrical stimulation, suggesting a possible role in evaluation and diagnosis of these patients. A direct correlation between LGE and VT prediction has been identified only in chronic Chagas' heart disease, but not in viral myocarditis. In CAD, infarct size is the strongest predictor of VT inducibility. The peri-infarct zone may also play a role; however, further studies are needed for definite conclusions. Left ventricle, RV, right ventricular outflow tract (RVOT) function, pulmonary regurgitation and LGE around the infundibular patch and RV anterior wall play an important role in the VT prediction in repaired Tetralogy of Fallot. Finally, in treated transposition of great arteries, the extent of LGE in the systemic RV correlates with age, ventricular dysfunction, electrophysiological parameters and adverse clinical events, suggesting prognostic importance.
室性心动过速（VT）是发达国家心脏性猝死（SCD）的最常见原因。在 30 岁以上人群中，冠状动脉疾病（CAD）是 VT 最常见的原因，而在 30 岁以下人群中，肥厚型心肌病（HCM）、心肌炎和先天性心脏病是 VT 的常见原因。心脏磁共振（CMR）是一种非侵入性、非放射性技术，可可靠地检测心室容积和射血分数的变化，这些变化可预测 VT/SCD。此外，CMR 能够通过延迟钆增强图像（LGE）进行组织特征分析，并检测水肿、脂肪和纤维基质，从而预测缺血性和非缺血性心肌病中的 VT/SCD。HCM 中的 LGE 程度与 SCD 的危险因素和诱导性 VT 的可能性相关。在特发性扩张型心肌病中，CMR 评估的中层纤维化程度也预测 SCD/VT。此外，在致心律失常性右心室（RV）发育不良/心肌病中，CMR 与组织病理学具有极好的相关性，并预测程序电刺激下的诱导性 VT，表明其在这些患者的评估和诊断中可能具有一定作用。仅在慢性恰加斯心脏病中，LGE 与 VT 预测之间存在直接相关性，但在病毒性心肌炎中则没有。在 CAD 中，梗死面积是预测 VT 诱导性的最强指标。梗死周围区也可能起作用；然而，还需要进一步的研究来得出明确的结论。左心室、RV、右心室流出道（RVOT）功能、肺动脉瓣反流和漏斗区周围及 RV 前壁的 LGE 在修复后的法洛四联症的 VT 预测中起着重要作用。最后，在治疗性大动脉转位中，系统 RV 中的 LGE 程度与年龄、心室功能障碍、电生理参数和不良临床事件相关，表明其具有预后意义。
