Arrhythmia Department, Teknon Heart Institute, Teknon Medical Center, C/Vilana 12, 08022 Barcelona, Spain.
Cardiology Unit, Department of Clinical and Molecular Medicine, Sant'Andrea Hospital, University Sapienza, Rome, Italy.
Europace. 2024 Mar 1;26(3). doi: 10.1093/europace/euae050.
Late gadolinium enhancement cardiac magnetic resonance (LGE-CMR) detects myocardial scarring, a risk factor for ventricular arrhythmias (VAs) in hypertrophic cardiomyopathy (HCM). The LGE-CMR distinguishes core, borderzone (BZ) fibrosis, and BZ channels, crucial components of re-entry circuits. We studied how scar architecture affects inducibility and electrophysiological traits of VA in HCM.
We correlated scar composition with programmed ventricular stimulation-inducible VA features using LGE intensity maps. Thirty consecutive patients were enrolled. Thirteen (43%) were non-inducible, 6 (20%) had inducible non-sustained, and 11 (37%) had inducible sustained mono (MMVT)- or polymorphic VT/VF (PVT/VF). Of 17 induced VA, 13 (76%) were MMVT that either ended spontaneously, persisted as sustained monomorphic, or degenerated into PVT/VF. Twenty-seven patients (90%) had LGE. Of these, 17 (57%) had non-sustained or sustained inducible VA. Scar mass significantly increased (P = 0.002) from non-inducible to inducible non-sustained and sustained VA patients in both the BZ and core components. Borderzone channels were found in 23%, 67%, and 91% of non-inducible, inducible non-sustained, and inducible sustained VA patients (P = 0.003). All 13 patients induced with MMVT or monomorphic-initiated PVT/VF had LGE. The origin of 10/13 of these VTs matched scar location, with 8/10 of these LGE regions showing BZ channels. During follow-up (20 months, interquartile range: 7-37), one patient with BZ channels and inducible PVT had an ICD shock for VF.
Scar architecture determines inducibility and electrophysiological traits of VA in HCM. Larger studies should explore the role of complex LGE patterns in refining risk assessment in HCM patients.
晚期钆增强心脏磁共振（LGE-CMR）可检测心肌瘢痕，这是肥厚型心肌病（HCM）中室性心律失常（VA）的危险因素。LGE-CMR 可区分核心、边缘区（BZ）纤维化和 BZ 通道，这是折返环的关键组成部分。我们研究了瘢痕结构如何影响 HCM 中 VA 的可诱导性和电生理特征。
我们使用 LGE 强度图将瘢痕组成与程序心室刺激诱导的 VA 特征相关联。连续纳入 30 例患者。13 例（43%）为非诱导性，6 例（20%）为诱导性非持续性，11 例（37%）为诱导性持续性单形（MMVT）或多形性 VT/VF（PVT/VF）。17 例诱导性 VA 中，13 例（76%）为 MMVT，要么自行终止，要么持续为持续性单形，要么发展为 PVT/VF。27 例患者（90%）有 LGE。其中，17 例（57%）有非持续性或持续性可诱导性 VA。非诱导性到诱导性非持续性和持续性 VA 患者的 BZ 和核心成分中的瘢痕质量均显著增加（P = 0.002）。在非诱导性、诱导性非持续性和诱导性持续性 VA 患者中，分别有 23%、67%和 91%存在 BZ 通道（P = 0.003）。所有 13 例用 MMVT 或单形起始 PVT/VF 诱导的患者均有 LGE。其中 10/13 例 VT 的起源与瘢痕位置相匹配，其中 8/10 例 LGE 区域存在 BZ 通道。在随访期间（20 个月，四分位间距：7-37），1 例有 BZ 通道和可诱导性 PVT 的患者因 VF 发生 ICD 电击。
瘢痕结构决定了 HCM 中 VA 的可诱导性和电生理特征。更大的研究应该探讨复杂的 LGE 模式在细化 HCM 患者风险评估中的作用。
