Late gadolinium enhancement extent in specific arrhythmogenic segments was significantly greater in patients with ventricular arrhythmias compared to those without (2.07 vs 0.65 segments, p<0.001).
Cohort (n=61)
No
Does the specific location of late gadolinium enhancement on cardiac magnetic resonance predict the occurrence of ventricular arrhythmias and sudden cardiac death in patients with hypertrophic cardiomyopathy?
The specific location of late gadolinium enhancement, particularly in areas of increased mechanical stress, is independently associated with ventricular arrhythmias in HCM patients, improving sudden cardiac death risk stratification.
Effect estimate: AUC 0.861
p-value: p=<0.001
Late gadolinium enhancement (LGE) extent has emerged as a predictor of sudden cardiac death (SCD) in patients with hypertrophic cardiomyopathy (HCM), however little is known about the arrhythmogenic relevance of its specific location in the left ventricle. Our aim was to analyze the influence of LGE location on the occurrence of ventricular arrhythmias (VA) and SCD in patients with HCM. We performed a retrospective analysis of clinical and Holter records of HCM patients who underwent cardiac magnetic resonance at our center. LGE extent and distribution were assessed using the American Heart Association 17-segment model. VA was defined as non-sustained or sustained ventricular tachycardia, ventricular fibrillation or SCD. Sixty-one patients (age 57.0±16.7 years) were included and VA occurred in 24.6% (n=15). Patients with VA showed greater LGE extent than those without (7.40±5.3 vs. 3.52±3.0 segments, p=0.007). Analyzing the distribution of LGE, a set of arrhythmogenic segments (apex/basal inferior/basal anterolateral/mid inferoseptal) was found. The extent of LGE involvement in these segments was also greater in patients with VA (2.07±1.03 vs. 0.65±0.71 segments, p<0.001; area under the curve 0.861 for VA) and this difference remained significant after adjustment for potentially confounding variables. The extent of LGE involvement of a set of segments with an apparent relation to cardiac areas of increased mechanical stress was significantly and independently associated with the occurrence of VA, suggesting that not only the extent but also the location of LGE is important for the assessment of SCD risk in HCM patients. A extensão do realce tardio (RT) tem surgido como preditor de morte súbita cardíaca (MSC) em doentes com miocardiopatia hipertrófica (MCH), contudo pouco se conhece quanto à relevância arritmogénica da sua localização específica no ventrículo esquerdo. O nosso objetivo foi avaliar a influência da localização do RT na ocorrência de arritmias ventriculares/morte súbita (AV) em doentes com MCH. Análise retrospetiva de dados clínicos e Holters de doentes com MCH submetidos a ressonância magnética no nosso centro. A extensão e a distribuição do RT foram avaliadas usando o modelo de 17 segmentos da American Heart Association. Foi definido AV como a ocorrência de taquicardia ventricular não sustentada ou sustentada, fibrilhação ventricular ou paragem cardíaca súbita. Foram incluídos 61 doentes (57,0±16,7 anos), tendo ocorrido AV em 24,6% (n=15). Os doentes com AV apresentavam maior extensão de RT do que aqueles sem AV (7,40±5,3 versus 3,52±3,0 segmentos, p=0,007). Analisando a distribuição do RT foi encontrado um conjunto de segmentos arritmogénicos (basal inferior/basal anterolateral/médio inferosseptal/ápex). A extensão de RT nestes segmentos foi também maior nos doentes com AV (2,07±1,03 versus 0,65±0,71 segmentos, p<0,001; área sob a curva ROC 0,861 para AV). Esta diferença permaneceu significativa após ajuste para potenciais variáveis confundidoras. A extensão do RT num conjunto de segmentos com aparente relação com áreas cardíacas de maior stress mecânico associou-se significativa e independentemente à ocorrência de AV, sugerindo que não apenas a extensão mas também a localização do RT é importante na avaliação do risco de MSC em doentes com MCH.
Barbosa et al. (Sun,) conducted a cohort in Hypertrophic cardiomyopathy (n=61). Late gadolinium enhancement (LGE) location and extent vs. Lower LGE extent or different location was evaluated on Ventricular arrhythmias (non-sustained or sustained ventricular tachycardia, ventricular fibrillation or sudden cardiac death) (AUC 0.861, p=<0.001). Late gadolinium enhancement extent in specific arrhythmogenic segments was significantly greater in patients with ventricular arrhythmias compared to those without (2.07 vs 0.65 segments, p<0.001).
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