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Prognostic role of magnetic-resonance imaging in patients with nonischemic ventricular arrhythmias

Authors: Berdibekov B.Sh., Aleksandrova S.A., Gromova O.I., Meladze M.G., Golukhova E.Z.

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

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Type:  Original articles


DOI: https://doi.org/10.24022/1997-3187-2022-16-2-199-215

For citation: Berdibekov B.Sh., Aleksandrova S.A., Gromova O.I., Meladze M.G., Golukhova E.Z. Prognostic role of magnetic-resonance imaging in patients with nonischemic ventricular arrhythmias. Creative Cardiology. 2022; 16 (2): 199–215 (in Russ.). DOI: 10.24022/1997-3187-2022-16-2-199-215

Received / Accepted:  15.01.2022 / 14.06.2022

Keywords: sudden cardiac death magnetic-resonance tomography late gadolinium enhancement implantable cardioverter-defibrillator

Full text:  

 

Abstract

Objective. To explore whether the extent of late gadolinium enhancement (LGE) would improve risk stratification in patients with a nonischemic ventricular arrhythmias with an indication for implantable cardioverter-defibrillator (ICD) therapy for the primary and secondary prevention of sudden cardiac death (SCD).

Material and methods. The study included 56 patients, 62.5% male; the mean age was 48.1 ± 12.2 years; the median of left ventricular ejection fraction was 44 [33.5–61.5] % ICD/CRT-D implantations were performed for primary prevention in 27 (48.2%) patients and in 29 (51.8%) patients – for secondary prevention of SCD. LGE extent was quantified using the full-width half-maximum (FWHM). The primary endpoint was appropriate ICD discharge.

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 FWHM method was 5.1 [3.0–10.6] %. By Cox univariate regression analysis, previous syncope HR: 3.14 (CI: 1.28–7.73) and sustained ventricular tachycardia (VT), HR: 8.24 (CI: 2.43–27.96) and extent of LGE, HR: 1,067; per 1% increase in the extent of LGE (CI: 1.029–1.107) demonstrated the strongest association with appropriate ICD discharge. In multivariate regression analysis of Cox, the history of sustained VT, HR: 9,17 (CI: 2.60–32.38; p = 0.001) and the value of the extent of LGE, HR: 1,081; per 1% increase in volume of LGE (CI: 1.034–1.131; p = 0.001) demonstrated an independent association with the appropriate ICD discharge.

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.

References

  1. Bockeria L.A., Revishvili A.Sh., Ardashev A.V., Kochovich D.Z. Ventricular arrhythmias. Moscow: Medpraktika; 2002 (in Russ.).
  2. Golukhova E.Z. Sudden cardiac death. Did the results of randomized trials change our opinion of the possible predictors and the ways to prevent? Creative Cardiology. 2008; 1: 7–24 (in Russ.).
  3. Gromova O.I., Aleksandrova S.A., Makarenko V.N., Golukhova E.Z. Modern predictors of life-threatening arrhythmias. Creative Cardiology. 2012; 2: 30–46 (in Russ.).
  4. Hallstrom A.P., McAnulty J.H., Wilkoff B.L., Follmann D., Raitt M.H., Carlson M.D. et al. Antiarrhythmics Versus Implantable Defibrillator (AVID) Trial Investigators. Patients at lower risk of arrhythmia recurrence: a subgroup in whom implantable defibrillators may not offer benefit. Antiarrhythmics Versus Implantable Defibrillator (AVID) Trial Investigators. J. Am. Coll. Cardiol. 2001; 37 (4): 1093–9. DOI: 10.1016/s0735-1097(00)01208-0
  5. Moss A.J., Greenberg H., Case R.B., Zareba W., Hall W.J., Brown M.W. et al. Multicenter Automatic Defibrillator Implantation Trial-II (MADIT-II) Research Group. Long-term clinical course of patients after termination of ventricular tachyarrhythmia by an implanted defibrillator. Circulation. 2004; 110 (25): 3760–5. DOI: 10.1161/01.CIR.0000150390.04704.B7
  6. Kuck K.H., Cappato R., Siebels J., Rüppel R. Randomized comparison of antiarrhythmic drug therapy with implantable defibrillators in patients resuscitated from cardiac arrest : the Cardiac Arrest Study Hamburg (CASH). Circulation. 2000; 102 (7): 748–54. DOI: 10.1161/01.cir.102.7.748
  7. Connolly S.J., Gent M., Roberts R.S., Dorian P., Roy D., Sheldon R.S. et al. Canadian implantable defibrillator study (CIDS): a randomized trial of the implantable cardioverter defibrillator against amiodarone. Circulation. 2000; 101 (11): 1297–302. DOI: 10.1161/01.cir.101.11.1297
  8. Antiarrhythmics versus Implantable Defibrillators (AVID) Investigators. A comparison of antiarrhythmic-drug therapy with implantable defibrillators in patients resuscitated from nearfatal ventricular arrhythmias. N. Engl. J. Med. 1997; 337 (22): 1576–83. DOI: 10.1056/NEJM 199711273372202
  9. Domanski M.J., Sakseena S., Epstein A.E., Hallstrom A.P., Brodsky M.A., Kim S., et al. Relative effectiveness of the implantable cardioverter-defibrillator and antiarrhythmic drugs in patients with varying degrees of left ventricular dysfunction who have survived malignant ventricular arrhythmias. AVID Investigators. Antiarrhythmics Versus Im-plan-table Defibrillators. J. Am. Coll. Cardiol. 1999; 34 (4): 1090–5. DOI: 10.1016/s0735-1097(99)00327-7
  10. Stecker E.C., Vickers C., Waltz J., Socoteanu C., John B.T., Mariani R. et al. Population-based analysis of sudden cardiac death with and without left ventricular systolic dysfunction: two-year findings from the Oregon Sudden Unexpected Death Study. J. Am. Coll. Cardiol. 2006; 47 (6): 1161–6. DOI: 10.1016/j.jacc.2005.11.045
  11. Wu K.C., Calkins H. Powerlessness of a number: why left ventricular ejection fraction matters less for sudden cardiac death risk assessment. Circ. Cardiovasc. Imaging. 2016; 9 (10): e005519. DOI: 10.1161/CIRCIMAGING.116.005519
  12. Notaristefano F., Ambrosio G. Defibrillator and non-ischaemic dilated cardiomyopathy: a never ending story. Eur. Heart J. Suppl. 2019; 21 (Suppl B): B5–B6. DOI: 10.1093/eurheartj/suz005
  13. 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
  14. Neilan T.G., Coelho-Filho O.R., Danik S.B., Shah R.V., Dodson J.A., Verdini D.J. et al. CMR quantification of myocardial scar provides additive prognostic information in nonischemic cardiomyopathy. JACC Cardiovasc. Imaging. 2013; 6 (9): 944–54. DOI: 10.1016/j.jcmg.2013.05.013
  15. Funada A., Kanzaki H., Noguchi T., Morita Y., Sugano Y., Ohara T. et al. Prognostic significance of late gadolinium enhancement quantification in cardiac magnetic resonance imaging of hypertrophic cardiomyopathy with systolic dysfunction. Heart Vessels. 2016; 31 (5): 758–70. DOI: 10.1007/s00380-015-0670-4
  16. Scott P.A., Rosengarten J.A., Murday D.C., Peebles C.R., Harden S.P., Curzen N.P., Morgan J.M. Left ventricular scar burden specifies the potential for ventricular arrhythmogenesis: an LGE-CMR study. J. Cardiovasc. Electrophysiol. 2013; 24 (4): 430–6. DOI: 10.1111/jce.12035

About Authors

  • Bektur Sh. Berdibekov, Cardiologist, Postgraduate; ORCID
  • Svetlana A. Aleksandrova, Cand. Med. Sci., Senior Research Associate; ORCID
  • Ol’ga I. Gromova, Cand. Med. Sci., Cardiologist, Researcher; ORCID
  • Maya G. Meladze, Researcher; ORCID
  • Elena Z. Golukhova, Dr. Med. Sci., Academician of Russian Academy of Sciences, Professor, Head of Department; 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


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