Institut Clinic Cardiovascular, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.
Institut Clinic Cardiovascular, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
Heart Rhythm. 2021 Aug;18(8):1336-1343. doi: 10.1016/j.hrthm.2021.04.017. Epub 2021 Apr 21.
Scar characteristics analyzed by late gadolinium enhancement cardiac magnetic resonance (LGE-CMR) are related with ventricular arrhythmias. Current guidelines are based only on the left ventricular ejection fraction to recommend an implantable cardioverter-defibrillator (ICD) in primary prevention.
Our study aims to analyze the role of imaging to stratify arrhythmogenic risk in patients with ICD for primary prevention.
From 2006 to 2017, we included 200 patients with LGE-CMR before ICD implantation for primary prevention. The scar, border zone, core, and conducting channels (CCs) were automatically measured by a dedicated software.
The mean age was 60.9 ± 10.9 years; 81.5% (163) were men; 52% (104) had ischemic cardiomyopathy. The mean left ventricular ejection fraction was 29% ± 10.1%. After a follow-up of 4.6 ± 2 years, 46 patients (22%) reached the primary end point (appropriate ICD therapy). Scar mass (36.2 ± 19 g vs 21.7 ± 10 g; P < .001), border zone mass (26.4 ± 12.5 g vs 16.0 ± 9.5 g; P < .001), core mass (9.9 ± 8.6 g vs 5.5 ± 5.7 g; P < .001), and CC mass (3.0 ± 2.6 g vs 1.6 ± 2.3 g; P < .001) were associated with appropriate therapies. Scar mass > 10 g (25.31% vs 5.26%; hazard ratio 4.74; P = .034) and the presence of CCs (34.75% vs 8.93%; hazard ratio 4.07; P = .003) were also strongly associated with the primary end point. However, patients without channels and with scar mass < 10 g had a very low rate of appropriate therapies (2.8%).
Scar characteristics analyzed by LGE-CMR are strong predictors of appropriate therapies in patients with ICD in primary prevention. The absence of channels and scar mass < 10 g can identify patients at a very low risk of ventricular arrhythmias in this population.
通过晚期钆增强心脏磁共振（LGE-CMR）分析的瘢痕特征与室性心律失常有关。目前的指南仅基于左心室射血分数（LVEF）建议在一级预防中植入式心脏复律除颤器（ICD）。
我们的研究旨在分析影像在一级预防中植入 ICD 患者的心律失常危险分层中的作用。
2006 年至 2017 年，我们纳入了 200 例因一级预防而植入 ICD 前接受 LGE-CMR 的患者。瘢痕、边界区、核心和传导通道（CCs）由专用软件自动测量。
平均年龄为 60.9 ± 10.9 岁；81.5%（163 例）为男性；52%（104 例）为缺血性心肌病。平均左心室射血分数为 29% ± 10.1%。在 4.6 ± 2 年的随访后，46 例（22%）达到了主要终点（合适的 ICD 治疗）。瘢痕质量（36.2 ± 19 g 比 21.7 ± 10 g；P <.001）、边界区质量（26.4 ± 12.5 g 比 16.0 ± 9.5 g；P <.001）、核心质量（9.9 ± 8.6 g 比 5.5 ± 5.7 g；P <.001）和 CC 质量（3.0 ± 2.6 g 比 1.6 ± 2.3 g；P <.001）与合适的治疗相关。瘢痕质量>10 g（25.31%比 5.26%；危险比 4.74；P =.034）和 CCs 的存在（34.75%比 8.93%；危险比 4.07；P =.003）也与主要终点密切相关。然而，无 CCs 且瘢痕质量<10 g 的患者合适治疗的发生率非常低（2.8%）。
LGE-CMR 分析的瘢痕特征是一级预防中植入 ICD 患者合适治疗的有力预测因子。无 CCs 和瘢痕质量<10 g 可识别出该人群中室性心律失常风险极低的患者。
