Disertori Marcello, Masè Michela, Ravelli Flavia
Healthcare Research and Innovation Program, PAT-FBK, Trento, Italy; Department of Cardiology, Santa Chiara Hospital, Trento, Italy.
Department of Physics, University of Trento, Povo, Trento, Italy.
Trends Cardiovasc Med. 2017 Jul;27(5):363-372. doi: 10.1016/j.tcm.2017.01.011. Epub 2017 Feb 2.
Myocardial fibrosis is a common pattern in the setting of different heart diseases, and promotes ventricular tachyarrhythmias by creating a vulnerable substrate for reentrant activity and by favoring the emergence of triggers. Currently, late gadolinium enhancement (LGE) cardiac magnetic resonance is considered the reference method for the noninvasive assessment of ventricular fibrosis. Several studies and meta-analyses have shown that ventricular fibrosis detected by LGE is a powerful predictor of ventricular tachyarrhythmic events in ischemic, non-ischemic dilated cardiomyopathy and hypertrophic cardiomyopathy patients. Both the presence and extension of ventricular fibrosis were shown to correlate with the occurrence of ventricular arrhythmias and sudden cardiac death, irrespective of the grade of left ventricular dysfunction. Based on these results, the assessment of ventricular fibrosis has been suggested as a candidate marker to improve the decision making for implantable cardioverter-defibrillator therapy in patients with left ventricular dysfunction. These points will be discussed in the review.
心肌纤维化是不同心脏病背景下的常见模式，它通过为折返活动创造易损基质并促进触发因素的出现来引发室性快速性心律失常。目前，钆延迟增强（LGE）心脏磁共振成像被认为是无创评估心室纤维化的参考方法。多项研究和荟萃分析表明，LGE检测到的心室纤维化是缺血性、非缺血性扩张型心肌病和肥厚型心肌病患者室性快速性心律失常事件的有力预测指标。心室纤维化的存在和范围均与室性心律失常和心源性猝死的发生相关，而与左心室功能障碍的程度无关。基于这些结果，心室纤维化评估被建议作为一种候选标志物，以改善左心室功能障碍患者植入式心脏复律除颤器治疗的决策。这些要点将在本综述中进行讨论。
