Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
JACC Cardiovasc Imaging. 2013 Nov;6(11):1152-9. doi: 10.1016/j.jcmg.2013.05.017.
This study evaluated whether the conductive channel (CC) identified by late gadolinium enhanced-cardiac magnetic resonance (LGE-CMR) is associated with ventricular tachycardia (VT) in patients with systolic heart failure (HF).
One recent study demonstrated that the CC formed by heterogeneous tissue within the core scar could be detected by LGE-CMR and that the CC is responsible for clinical VT. We hypothesized that the CC could help identify HF patients at risk for VT.
A total of 63 patients from a CMR database with left ventricular ejection fraction (LVEF) below 50% and with hyperenhancement on LGE-CMR were included. The cine and LGE images were analyzed to derive the LV function and scar characteristics, and to identify the CC. The outcomes, including VT, ventricular fibrillation (VF), and total mortality, were obtained by reviewing medical records.
After a median 1,379 (interquartile range: 271 to 1,896) days of follow-up, 8 patients had VT/VF attacks and 14 patients died. Among the CMR-measured parameters, only the probability of identifying the CC by LGE-CMR was higher in patients with VT/VF than those without VT/VF (75.0% vs. 16.4%, p < 0.001). The probability of identifying the CC was also higher in the total mortality group than the survival group (50.0% vs. 16.3%, p = 0.004). The other LGE-CMR variables were not significantly different between the 2 groups. A univariate Cox regression model showed that CC identification was positively associated with VT/VF attacks (hazard ratio [HR]: 27.032, 95% confidence interval [CI]: 3.291 to 222.054, p = 0.002) and excess total mortality (HR: 4.766, 95% CI: 1.643 to 13.824, p = 0.004). The LVEF was inversely associated with VT/VF attacks (HR: 0.119, 95% CI: 0.015 to 0.977, p = 0.048) and excess total mortality (HR: 0.491, 95% CI: 0.261 to 0.925, p = 0.028) during follow-up.
We demonstrated that CC identification using LGE-CMR can help identify HF patients at risk for VT/VF.
本研究旨在评估心脏磁共振晚期钆增强（LGE-CMR）检测到的传导通道（CC）是否与射血分数降低的心力衰竭（HF）患者的室性心动过速（VT）有关。
最近的一项研究表明，LGE-CMR 可检测到核心瘢痕内异质性组织形成的 CC，CC 与临床 VT 有关。我们假设 CC 可帮助识别 HF 患者发生 VT 的风险。
纳入了左心室射血分数（LVEF）<50%且 LGE-CMR 显示有高信号的 63 例患者。分析电影和 LGE 图像，以获得 LV 功能和瘢痕特征，并识别 CC。通过查阅病历获得 VT、心室颤动（VF）和总死亡率等结局。
中位随访 1379 天（四分位距：271 至 1896 天）后，8 例患者发生 VT/VF 发作，14 例患者死亡。在 CMR 测量的参数中，仅 LGE-CMR 识别 CC 的概率在 VT/VF 患者中高于无 VT/VF 患者（75.0% vs. 16.4%，p<0.001）。CC 识别率在总死亡率组也高于存活率组（50.0% vs. 16.3%，p=0.004）。两组间其他 LGE-CMR 变量无显著差异。单因素 Cox 回归模型显示，CC 识别与 VT/VF 发作呈正相关（危险比[HR]：27.032，95%置信区间[CI]：3.291 至 222.054，p=0.002）和总死亡率过高（HR：4.766，95%CI：1.643 至 13.824，p=0.004）。LVEF 与 VT/VF 发作呈负相关（HR：0.119，95%CI：0.015 至 0.977，p=0.048）和总死亡率过高（HR：0.491，95%CI：0.261 至 0.925，p=0.028）。
我们证实，使用 LGE-CMR 识别 CC 可帮助识别 HF 患者发生 VT/VF 的风险。
