Contrast-enhanced cardiac magnetic resonance (CMR) with late gadolinium enhancement (LGE) detects myocardial fibrosis in patients with hypertro- phic cardiomyopathy (HCM). We conducted a retrospective analysis of a pro- spectively collected and followed up cohort of consecutive patients with HCM implanted with a cardioverter defibrillator (ICD) that underwent pre- implant CMR. We sought to describe scar architecture and assess scar composition as a predictor of ven- tricular tachycardia/ventricular fibrillation (VT/VF). High scar mass (>15% of LV mass) showed 44.8% positive predictive value (PPV) and 89.7% negative predictive value (NPV) for VT/VF, whereas BZ chan- nels identified VT/VF patients with 55.6% PPV and 96.8% NPV. Indeed, of 28 patients with scar <15%, 3 had VT/VF, and 2 of them had BZ channels. The C-statistic was 0.77 (95% CI: 0.64-0.89) for scar mass and 0.88 (95% CI: 0.76-0.96) for BZ channels (P 1⁄4 0.11). Using scar channels instead of scar mass to stratify the risk of VT/VF allowed us to reclassify 12.5% of the cases and 12.0% of the controls (net reclassification index [NRI]: 0.24; SE: 0.10; P 1⁄4 0.01). High-risk patients with HCM displayed extensive LV scar with predominance of BZ tissue and relatively common BZ channels in the scar volume, possibly serving as substrates for re-entrant VA.

Substrates of scar-related ventricular arrhythmia in patients with hypertrophic cardiomyopathy: a cardiac magnetic resonance study / Francia, Pietro; Ocaña-Franco, Paula; Cristiano, Ernesto; Falasconi, Giulio; Adduci, Carmen; Soto-Iglesias, David; Penela, Diego; Sclafani, Matteo; Martì-Almor, Julio; Musumeci, Beatrice; Autore, Camillo; Berruezo, Antonio. - In: JACC. CARDIOVASCULAR IMAGING. - ISSN 1936-878X. - (2023), pp. 1-4. [10.1016/j.jcmg.2023.03.016]

Substrates of scar-related ventricular arrhythmia in patients with hypertrophic cardiomyopathy: a cardiac magnetic resonance study

Francia, Pietro;Adduci, Carmen;Sclafani, Matteo;Musumeci, Beatrice;Autore, Camillo;
2023

Abstract

Contrast-enhanced cardiac magnetic resonance (CMR) with late gadolinium enhancement (LGE) detects myocardial fibrosis in patients with hypertro- phic cardiomyopathy (HCM). We conducted a retrospective analysis of a pro- spectively collected and followed up cohort of consecutive patients with HCM implanted with a cardioverter defibrillator (ICD) that underwent pre- implant CMR. We sought to describe scar architecture and assess scar composition as a predictor of ven- tricular tachycardia/ventricular fibrillation (VT/VF). High scar mass (>15% of LV mass) showed 44.8% positive predictive value (PPV) and 89.7% negative predictive value (NPV) for VT/VF, whereas BZ chan- nels identified VT/VF patients with 55.6% PPV and 96.8% NPV. Indeed, of 28 patients with scar <15%, 3 had VT/VF, and 2 of them had BZ channels. The C-statistic was 0.77 (95% CI: 0.64-0.89) for scar mass and 0.88 (95% CI: 0.76-0.96) for BZ channels (P 1⁄4 0.11). Using scar channels instead of scar mass to stratify the risk of VT/VF allowed us to reclassify 12.5% of the cases and 12.0% of the controls (net reclassification index [NRI]: 0.24; SE: 0.10; P 1⁄4 0.01). High-risk patients with HCM displayed extensive LV scar with predominance of BZ tissue and relatively common BZ channels in the scar volume, possibly serving as substrates for re-entrant VA.
2023
hypertrophic cardiomyopathy; scar; ICD; LGE
01 Pubblicazione su rivista::01a Articolo in rivista
Substrates of scar-related ventricular arrhythmia in patients with hypertrophic cardiomyopathy: a cardiac magnetic resonance study / Francia, Pietro; Ocaña-Franco, Paula; Cristiano, Ernesto; Falasconi, Giulio; Adduci, Carmen; Soto-Iglesias, David; Penela, Diego; Sclafani, Matteo; Martì-Almor, Julio; Musumeci, Beatrice; Autore, Camillo; Berruezo, Antonio. - In: JACC. CARDIOVASCULAR IMAGING. - ISSN 1936-878X. - (2023), pp. 1-4. [10.1016/j.jcmg.2023.03.016]
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11573/1682995
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