对缺血性心肌病植入式心律转复除颤器（ICD）患者瘢痕组织范围和异质性的磁共振评估可预测室性心律失常。
Magnetic resonance estimates of the extent and heterogeneity of scar tissue in ICD patients with ischemic cardiomyopathy predict ventricular arrhythmia.
作者信息
Zeidan-Shwiri Tawfiq, Yang Yuesong, Lashevsky Ilan, Kadmon Ehud, Kagal Darren, Dick Alexander, Laish Farkash Avishag, Paul Gideon, Gao Donsheng, Shurrab Mohammed, Newman David, Wright Graham, Crystal Eugene
机构信息
Arrhythmia Services, Schulich Heart Centre, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada.
Arrhythmia Services, Schulich Heart Centre, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada.
出版信息
Heart Rhythm. 2015 Apr;12(4):802-8. doi: 10.1016/j.hrthm.2015.01.007. Epub 2015 Jan 9.
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.
背景
根据当前指南接受植入式心脏复律除颤器（ICD）植入的大多数患者从未发生持续性室性心律失常；因此，需要更好的持续性室性心动过速和/或心室颤动风险标志物。
目的
本研究的目的是在ICD植入前确定缺血性心肌病的心脏磁共振心律失常风险预测指标。
方法
对43例曾发生心肌梗死且因ICD植入前来就诊的受试者（平均年龄64.5±11.9岁）进行心脏磁共振成像（MRI）评估。MRI方案包括使用稳态自由进动评估左心室功能参数，以及使用反转恢复快速梯度回波进行延迟钆增强MRI。使用心脏磁共振软件测量左心室功能参数。对受试者进行6 - 46个月的随访，并记录适当ICD治疗（电击和抗心动过速起搏）事件。
结果
在中位随访期30个月期间，28例患者发生了46次自发事件。接受适当ICD治疗的受试者的总心肌梗死（MI）面积（18.05±11.44 g对38.83±19.87 g；P = 0.0006）、MI核心（11.63±7.14 g对24.12±12.73 g；P = 0.0002）和梗死灰色带（6.43±4.64 g对14.71±7.65 g；P = 0.0004）显著大于未经历室性心动过速和/或心室颤动发作的受试者。对梗死灰色带和MI核心进行多变量回归分析，并根据纽约心脏协会分级、糖尿病和病因（一级或二级预防）进行调整，结果显示灰色带和MI核心是适当ICD治疗的预测指标（分别为P = 0.0018和P = 0.007）。
结论
MI瘢痕的范围可能预测哪些患者将从ICD植入中获益最大。
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