三维晚期钆增强心血管磁共振预测法洛四联症修复术后成人室性心动过速的可诱导性。
Three-Dimensional Late Gadolinium Enhancement Cardiovascular Magnetic Resonance Predicts Inducibility of Ventricular Tachycardia in Adults With Repaired Tetralogy of Fallot.
机构信息
Royal Brompton Hospital (S.G., S.E., J.K., A.G., V.S., I.V., G.C.S., M.B., C.M., T.W., S.Y.H., K.P.M., D.F.S., K.D., A.U., L.S., W.L., D.J.P., M.A.G., S.V.B.-N.), London, United Kingdom.
National Heart & Lung Institute, Imperial College (S.G., S.E., J.K., A.G., T.W., S.Y.H., K.D., W.L., D.J.P., M.A.G., S.V.B.-N.), London, United Kingdom.
出版信息
Circ Arrhythm Electrophysiol. 2020 Nov;13(11):e008321. doi: 10.1161/CIRCEP.119.008321. Epub 2020 Oct 6.
BACKGROUND
Adults with repaired tetralogy of Fallot die prematurely from ventricular tachycardia (VT) and sudden cardiac death. Inducible VT predicts mortality. Ventricular scar, the key substrate for VT, can be noninvasively defined with late gadolinium enhancement (LGE) cardiovascular magnetic resonance but whether this relates to inducible VT is unknown.
METHODS
Sixty-nine consecutive repaired tetralogy of Fallot patients (43 male, mean 40±15 years) clinically scheduled for invasive programmed VT-stimulation were prospectively recruited for prior 3-dimensional LGE cardiovascular magnetic resonance. Ventricular LGE was segmented and merged with reconstructed cardiac chambers and LGE volume measured.
RESULTS
VT was induced in 22 (31%) patients. Univariable predictors of inducible VT included increased RV LGE (odds ratio [OR], 1.15; =0.001 per cm), increased nonapical vent LV LGE (OR, 1.09; =0.008 per cm), older age (OR, 1.6; =0.01 per decile), QRS duration ≥180 ms (OR, 3.5; =0.02), history of nonsustained VT (OR, 3.5; =0.02), and previous clinical sustained VT (OR, 12.8; =0.003); only prior sustained VT (OR, 8.02; =0.02) remained independent in bivariable analyses after controlling for RV LGE volume (OR, 1.14; =0.003). An RV LGE volume of 25 cm had 72% sensitivity and 81% specificity for predicting inducible VT (area under the curve, 0.81; <0.001). At the extreme cutoffs for ruling-out and ruling-in inducible VT, RV LGE >10 cm was 100% sensitive and >36 cm was 100% specific for predicting inducible VT.
CONCLUSIONS
Three-dimensional LGE cardiovascular magnetic resonance-defined scar burden is independently associated with inducible VT and may help refine patient selection for programmed VT-stimulation when applied to an at least intermediate clinical risk cohort.
背景
患有法洛四联症（Fallot tetralogy）的成年人会因室性心动过速（VT）和心源性猝死而过早死亡。可诱发性 VT 可预测死亡率。心室瘢痕是 VT 的关键基质，可以通过晚期钆增强（LGE）心血管磁共振成像（CMR）进行无创性定义，但它与可诱发性 VT 的关系尚不清楚。
方法
连续前瞻性招募了 69 例临床计划行侵入性程控 VT 刺激的修复性法洛四联症患者（43 名男性，平均年龄 40±15 岁），并对其进行了先前的 3 维 LGE CMR。对 RV 和 LV 的 LGE 进行分段并与重建的心脏腔室融合，并测量 LGE 体积。
结果
22 例（31%）患者诱发出 VT。诱发性 VT 的单变量预测因子包括 RV LGE 增加（比值比 [OR]，1.15；每增加 1cm=0.001），非心尖部 LV 侧室 LGE 增加（OR，1.09；每增加 1cm=0.008），年龄较大（OR，1.6；每增加 1 个十分位数=0.01），QRS 持续时间≥180ms（OR，3.5；=0.02），非持续性 VT 史（OR，3.5；=0.02）和既往临床持续性 VT（OR，12.8；=0.003）；只有既往持续性 VT（OR，8.02；=0.02）在控制 RV LGE 体积后（OR，1.14；=0.003）仍为双变量分析中的独立因素。RV LGE 体积为 25cm 时，预测可诱发性 VT 的敏感性为 72%，特异性为 81%（曲线下面积，0.81；<0.001）。在预测可诱发性 VT 的排除和确诊的极值截止值处，RV LGE＞10cm 时预测可诱发性 VT 的敏感性为 100%，＞36cm 时特异性为 100%。
结论
三维 LGE CMR 定义的瘢痕负荷与可诱发性 VT 独立相关，当应用于至少中等临床风险队列时，可能有助于为程控 VT 刺激选择患者。
Zotero 插件