Noordman Alwin B P, Maass Alexander H, Groenveld Hessel, Mulder Bart A, Rienstra Michiel, Blaauw Yuri
Department of Cardiology, Heart Center, University of Groningen, University Medical Center Groningen, Groningen, Netherlands.
Front Cardiovasc Med. 2021 Aug 17;8:708406. doi: 10.3389/fcvm.2021.708406. eCollection 2021.
Implantable cardioverter-defibrillator (ICD) therapy is associated with several deleterious effects, which can be reduced by antiarrhythmic drugs or catheter ablation. However, it is largely unknown which patients might benefit from these therapies. Therefore, this study aimed to investigate whether myocardial scar characterization improves risk stratification for ventricular arrhythmia (VA) occurrence in patients with ischemic cardiomyopathy and an ICD. In this study, 82 patients with ischemic cardiomyopathy who received an ICD were enrolled retrospectively. Late gadolinium enhancement cardiac magnetic resonance (LGE-CMR) images were analyzed using an investigational software tool to obtain quantitative data regarding the total scar, core, and border zone (BZ). Data regarding the QRS complex was obtained from electrocardiography (ECG). The primary endpoint was appropriate ICD therapy. During a median follow-up duration of 3.98 years [interquartile range (IQR) 2.89-5.14 years], appropriate therapy occurred in 24 (29.3%) patients. Patients with appropriate ICD therapy had a significantly larger total scar mass [60.0 (IQR 41.2-73.4) vs. 43.3 (IQR 31.2-61.2) g; = 0.009] and BZ mass [32.9 (IQR 26.9-42.4) vs. 24.5 (IQR 18.8-32.5) g; = 0.001] than those without appropriate therapy. In multivariable Cox regression analyses, total scar mass [hazard ratio (HR) 1.02 [95% confidence interval (CI) 1.00-1.04]; = 0.014] and BZ mass (HR 1.04 [95% CI 1.01-1.07]; = 0.009) independently predicted appropriate ICD therapy. Core mass and the QRS complex, however, were not significantly associated with the primary endpoint. LGE-CMR-based, but not ECG-based myocardial scar characterization improves risk stratification for VA occurrence in patients with ischemic cardiomyopathy who received an ICD.
植入式心脏复律除颤器（ICD）治疗会带来多种有害影响，抗心律失常药物或导管消融可减轻这些影响。然而，很大程度上尚不清楚哪些患者可能从这些治疗中获益。因此，本研究旨在调查心肌瘢痕特征描述是否能改善缺血性心肌病且植入ICD患者发生室性心律失常（VA）的风险分层。在本研究中，回顾性纳入了82例接受ICD治疗的缺血性心肌病患者。使用一种研究性软件工具分析延迟钆增强心脏磁共振（LGE-CMR）图像，以获取有关总瘢痕、核心区和边缘区（BZ）的定量数据。从心电图（ECG）获取有关QRS波群的数据。主要终点是ICD的恰当治疗。在中位随访期3.98年[四分位间距（IQR）2.89 - 5.14年]期间，24例（29.3%）患者接受了恰当治疗。接受ICD恰当治疗的患者总瘢痕质量[60.0（IQR 41.2 - 73.4）g对43.3（IQR 31.2 - 61.2）g；P = 0.009]和BZ质量[32.9（IQR 26.9 - 42.4）g对24.5（IQR 18.8 - 32.5）g；P = 0.001]显著大于未接受恰当治疗的患者。在多变量Cox回归分析中，总瘢痕质量[风险比（HR）1.02[95%置信区间（CI）1.00 - 1.04]；P = 0.014]和BZ质量（HR 1.04[95%CI 1.01 - 1.07]；P = 0.009）独立预测ICD的恰当治疗。然而，核心区质量和QRS波群与主要终点无显著相关性。基于LGE-CMR而非基于ECG的心肌瘢痕特征描述可改善接受ICD治疗的缺血性心肌病患者发生VA的风险分层。
