Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan, USA.
Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA.
J Cardiovasc Electrophysiol. 2021 Mar;32(3):745-754. doi: 10.1111/jce.14884. Epub 2021 Jan 23.
Left ventricular noncompaction (LVNC) is associated with ventricular arrhythmias (VA) including premature ventricular complexes, and ventricular tachycardia (VT). The value of imaging with delayed enhancement cardiac magnetic resonance (DE-CMR) and programmed ventricular stimulation (PVS) for risk stratification in patients with VA and LVNC is unknown. The purpose of this study was to determine whether DE-CMR and PVS are beneficial for risk stratification and whether CMR helps to identify VA target sites.
Consecutive patients with LVNC undergoing ablation for VAs were included, all patients had preprocedure DE-CMR. A total of 23 patients (7 women, 46 ± 14 years, ejection fraction 35 ± 14) were included and followed for 2.9 ± 2.2 years. DE-CMR scar was present in 12/23 patients (52%). PVS was performed in 20/23 patients, 8/10 patients (80%) with scar were inducible for VT compared to 0/10 (0%) patients without scar (p < .001). VA target sites in patients with scarring were located adjacent to areas of scarring in all but 1 patient and ablation was successful in 15/23 patients (65%). Patients with scar had worse survival free of VT than those without scar (log rank p = .01) and patients with inducible VT had worse survival free of VT than those who were noninducible (log rank p < .001).
The presence of CMR defined scar in patients with LVNC was associated with inducible VT and worse outcomes. Inducibility for VT was associated with VT recurrence. Furthermore, CMR is beneficial in localizing the arrhythmogenic substrate in LVNC and therefore can aid in procedural planning.
左心室心肌致密化不全（LVNC）与室性心律失常（VA）相关，包括室性期前收缩和室性心动过速（VT）。在伴有 VA 和 LVNC 的患者中，延迟强化心脏磁共振（DE-CMR）和程控心室刺激（PVS）的影像学检查对风险分层的价值尚不清楚。本研究的目的是确定 DE-CMR 和 PVS 是否有助于风险分层，以及 CMR 是否有助于识别 VA 靶点。
连续纳入因 VA 而行消融术的 LVNC 患者，所有患者均行术前 DE-CMR。共纳入 23 例患者（7 例女性，年龄 46±14 岁，射血分数 35±14），随访 2.9±2.2 年。23 例患者中有 12 例（52%）存在 DE-CMR 瘢痕。23 例患者中有 20 例行 PVS，10 例（80%）有瘢痕的患者可诱发出 VT，而无瘢痕的 10 例（0%）患者无一例诱发出 VT（p<.001）。有瘢痕的患者 VA 靶点均位于瘢痕区附近，仅 1 例患者除外，23 例患者中有 15 例（65%）消融成功。有瘢痕的患者 VT 无复发的生存率低于无瘢痕的患者（log rank p=0.01），可诱发出 VT 的患者 VT 无复发的生存率低于不可诱发出 VT 的患者（log rank p<.001）。
LVNC 患者 CMR 定义的瘢痕与可诱发出 VT 及不良预后相关。VT 的可诱发性与 VT 复发相关。此外，CMR 有助于定位 LVNC 的致心律失常基质，因此有助于指导手术计划。
