Quantification of myocardial fibrosis in patients with a nonischemic ventricular arrhythmias by late gadolinium-enhanced magnetic resonance

Authors: Berdibekov B.Sh., Aleksandrova S.A., Golukhova E.Z.

Company: Bakoulev National Medical Research Center for Cardiovascular Surgery, Moscow, Russian Federation

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Type:  Reviews


DOI: https://doi.org/10.24022/1997-3187-2021-15-3-342-353

For citation: Berdibekov B.Sh., Aleksandrova S.A., Golukhova E.Z. Quantification of myocardial fibrosis in patients with a nonischemic ventricular arrhythmias by late gadolinium-enhanced magnetic resonance. Creative Cardiology. 2021; 15 (3): 342–53 (in Russ.). DOI: 10.24022/1997-3187-2021-15-3-342-353

Received / Accepted:  23.04.2021 / 03.09.2021

Keywords: magnetic resonance imaging ventricular arrhythmias myocardial fibrosis

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Abstract

Objective. The goal of this study was to identify the most reliable and reproducible semi-automatic method of late gadolinium enhancement (LGE) quantification to predict sudden cardiac death (SCD) risk in patients with a nonischemic ventricular arrhythmias.

Material and methods. The extent of LGE and clinical follow-up were assessed in 56 patients with a nonischemic ventricular arrhythmias prior to Implantable cardioverter defibrillators/ cardiac resynchronisation therapy (CRT) with defibrillator (ICD/CRT-D) insertion. Patients with LGE underwent different semi-automated quantification methods for LGE evaluation: 2-SD (standard deviation) and full width at half maximum (FWHM) (full width at half maximum). The primary endpoint was appropriate ICD/CRT-D discharge for sustained ventricular tachyarrhythmia.

Results. During a median follow-up of 18 [11.5–26.0] months the primary endpoint occurred in 22 patients. The median percentage of LV myocardium fibrosis assessed by the 2-SD method was 9.8 [6.0–18.8]%, while for the FWHM method it was 5.1 [3.0–10.6]% (p < 0.001). Intra-observer and inter-observer variability of the FWHM technique was excellent, intraclass correlation coefficients (ICC) 0.97 (95% CI 0.92–0.99) for intra-observer variability and 0.95 (95% CI 0.85–0.98) for inter-observer variability. The intraclass correlation coefficients for the 2- SD method were lower: 0.92 (95% CI 0.76–0.97) and 0.90 (95% CI 0.69–0.96), for intra- and inter-observer variability, respectively. Analysis of ROC curves revealed a percentage of LGE by volume of > 9,5% using the 2-SD method (area under the curve: 0.81 ± 0.06; 95% CI 0.69–0.93; sensitivity: 81.8%; specificity: 73.3%) and > 5,6% using the FWHM method (area under the curve: 0.88 ± 0.05; 95% CI: 0.78–0.97; sensitivity: 86.4%; specificity: 83.3%) as the optimal combination of sensitivity and specificity for the prediction of arrhythmic events.

Conclusion. LGE extent is an independent predictor of adverse outcomes in patients with nonischemic ventricular arrhythmia and may have an important role in risk stratification. FWHM is the optimal semi-automated quantification method in patients with nonischemic ventricular arrhythmias, demonstrating the highest technical consistency.

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About Authors

  • Bektur Sh. Berdibekov, Cardiologist; ORCID
  • Svetlana A. Aleksandrova, Cand. Med. Sci., Senior Researcher; ORCID
  • Elena Z. Golukhova, Dr. Med. Sci., Professor, Academician of RAS, Director; ORCID

Chief Editor

Leo A. Bockeria, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, President of Bakoulev National Medical Research Center for Cardiovascular Surgery