Cardiology Letters 2018, 27(1):20-26

Assessment of left ventricular arrhythmogenic substrate in patients with ischemic heart disease by cardiac magnetic resonance

Neuschl V¹, Berecova Z², Madaric J³, Simkova J¹, Glezlova A¹, Hatala R³

¹ Institute of Diagnostic Imaging, MRI s.r.o., Trnava

² Department of radiology, St. Michal Hospital, Bratislava

³ Department of Arrhythmias and Cardiac Pacing, Academic Divsion of Cardiology and Angiology, Medical Faculty, Slovak Medical University and National Cardiovascular Institute - NUSCH Bratislava, Slovakia

Background: The most common cause of sudden death is malignant ventricular tachyarrhythmia - ventricular tachycardia and ventricular fibrillation occurring based on the morphological substrate of the infarction scar.

Objectives: Results of qualitative and quantitative analysis of the scar and LV (left ventricular) function acquired by cardiac magnetic resonance (CMR) were correlated with the subsequent occurrence of malignant ventricular arrhythmias in patients with a high risk of sudden cardiac death (SCD).

Methods: We have prospectively followed 47 patients (mean age 60 ± 11 years) who were hospitalized for an implantable cardioverter-defibrillator (ICD) implantation to prevent SCD. All post-myocardial infarction (post-MI) patients had severe residual LV dysfunction (LVEF 33±14%). Patients were examined by CMR. In the CMR analysis, we evaluated the basic functional parameters of the LV as well as the mass, volume, transmurality and heterogeneity of the post-MI scar.

Results: The patients with malignant arrhythmias were characterized by smaller LV diameters in the enddiastole (LVED 192 ± 79 vs. 254 ± 47 mm, p = 0.003) and end-systole (LVES 131 ± 80 vs. 181 ± 45 mm, p = 0.01). As for the other observed functional and morphological CMR parameters, no significant differences between the two groups were detected.

Conclusion: These results indicate that post-MI patients with severe residual left ventricular dysfunction and dilatation are in the long-term characterized by a lower incidence of malignant arrhythmias compared to the patients with less dilated LV with a comparably severe LV dysfunction. Fig. 3, Tab. 2, Ref. 24, online full text (Free, PDF), www.cardiologyletters.sk Primárna práca bola uverejnená v: Neuschl V, Berecova Z, Madaric J, Simkova J, Glezlova A, Hatala R. Structural assessment of myocardial infarction scars and left ventricular function wit cardiac magnetic resonance imaging in patients with high risk of sudden cardiac death. Bratisl Med J 2018;119(5), in press.

Keywords: myocardial infarction; cardiac magnetic resonance imaging; ventricular tachyarrhythmias sudden cardiac death; implantable cardioverter defibrillator

Published: January 1, 2018  Show citation