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



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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.

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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