Myocardial scar mass independently predicted a lower probability of echocardiographic response to PVC ablation in patients with LV dysfunction (OR 0.9; 95% CI 0.81-0.99; p=0.04).
Cohort (n=70)
Does premature ventricular complex ablation improve left ventricular ejection fraction in patients with left ventricular dysfunction, and does myocardial scar influence this response?
In patients with LV dysfunction undergoing PVC ablation, the presence and mass of myocardial scar independently predict a lower probability of echocardiographic response, though it does not preclude improvement.
Estimación del efecto: OR 0.9 (95% CI 0.81-0.99)
valor p: p=0.04
OBJECTIVE: This study aims to evaluate the influence of myocardial scar after premature ventricular complexes (PVC) ablation in patients with left ventricular (LV) dysfunction. METHODS: 70 consecutive patients (58±11 years, 58 (83%) men, 23% (18-32) mean PVC burden) with LV dysfunction and frequent PVCs submitted for ablation were included. A late gadolinium enhancement cardiac magnetic resonance (LGE-CMR) was performed prior to the ablation and a quantitative and qualitative analysis of the scar was done. RESULTS: Left ventricular ejection fraction progressively improved from 34.3%±9% at baseline to 44.4%±12% at 12 months (p<0.01) and 48 (69%) patients were echocardiographic responders. New York Heart Association class improved from 1.96±0.9 points at baseline to 1.36±0.6 at 12 months (p<0.001). Brain natriuretic peptide decreased from 120 (60-284) to 46 (23-81) pg/mL (p=0.04). Twenty-nine (41%) patients showed scar in the preprocedural LGE-CMR with a mean scar mass of 10.4 (5-20) g. Mean scar mass was significantly smaller in responders than in non-responders (0 (0-4.7) g vs 2 (0-14) g, respectively, p=0.017). PVC burden reduction (OR 1.09 (1.01-1.16), p=0.02) and scar mass (OR 0.9 (0.81-0.99), p=0.04) were independent predictors of response, but the former showed a higher accuracy. CONCLUSIONS: Presence of myocardial scar modulates, but does not preclude, the probability of response to PVC ablation in patients with LV dysfunction.
Penela et al. (Fri,) conducted a cohort in Left ventricular dysfunction and frequent premature ventricular complexes (n=70). Premature ventricular complex (PVC) ablation was evaluated on Echocardiographic response (predicted by scar mass) (OR 0.9, 95% CI 0.81-0.99, p=0.04). Myocardial scar mass independently predicted a lower probability of echocardiographic response to PVC ablation in patients with LV dysfunction (OR 0.9; 95% CI 0.81-0.99; p=0.04).