A combination of ≥17.2 g border zone mass and the presence of border zone channels on CMR was associated with subsequent ventricular arrhythmia in STEMI patients (OR 9.40; 95% CI 3.26-27.13; P≤0.0001).
Case-Control (n=126)
Yes
Does the presence of ≥17.2 g scar border zone mass and border zone channels on CMR predict subsequent ventricular arrhythmia in patients with STEMI?
The combination of a scar border zone mass ≥17.2 g and the presence of border zone channels on CMR is a strong predictor of subsequent ventricular arrhythmias in STEMI survivors.
Effect estimate: OR 9.40 (95% CI 3.26-27.13)
p-value: p=≤ 0.0001
AIMS: Late gadolinium enhancement cardiac magnetic resonance (CMR) permits characterization of left ventricular ischaemic scars. We aimed to evaluate if scar core mass, border zone (BZ) mass, and BZ channels are risk markers for subsequent ventricular arrhythmia (VA) in ST-segment elevation myocardial infarction (STEMI). METHODS AND RESULTS: A sub-study of the DANish Acute Myocardial Infarction-3 multi-centre trial and Danegaptide phase II proof-of-concept clinical trial in which a total of 843 STEMI patients had a 3-month follow-up CMR. Of these, 21 patients subsequently experienced VA during 100 months of follow-up and were randomly matched 1:5 with 105 controls. A VA event was defined as: ventricular tachycardia, ventricular fibrillation, or sudden cardiac death. Ischaemic scar characteristics were automatically detected by specialized software. We included 126 patients with a median left ventricular ejection fraction of 51.0 ± 11.6% in cases with VA vs. 55.5 ± 8.5% in controls (P = 0.10). Cases had a larger mean BZ mass and more often BZ channels compared to controls BZ mass: 17.2 ± 10.3 g vs. 10.3 ± 6.0 g; P = 0.0002; BZ channels: 17 (80%) vs. 44 (42%); P = 0.001. A combination of ≥17.2 g BZ mass and the presence of BZ channels was five times more prevalent in cases vs. controls (P ≤ 0.00001) with an odds ratio of 9.40 (95% confidence interval 3.26-27.13; P ≤ 0.0001) for VA. This identified cases with 52% sensitivity and 90% specificity. CONCLUSION(S): Scar characterization with CMR indicates that a combination of ≥17.2 g BZ mass and the presence of BZ channels had the strongest association with subsequent VA in STEMI patients. CLINICALTRIALS.GOV: Unique identifier: NCT01435408 (DANAMI 3-iPOST and DANAMI 3-DEFER), NCT01960933 (DANAMI 3-PRIMULTI), and NCT01977755 (Danegaptide).
Thomsen et al. (Wed,) conducted a case-control in ST-segment elevation myocardial infarction (STEMI) (n=126). Scar border zone (BZ) mass and BZ channels assessed with CMR vs. Controls (no ventricular arrhythmia) was evaluated on Ventricular arrhythmia (ventricular tachycardia, ventricular fibrillation, or sudden cardiac death) (OR 9.40, 95% CI 3.26-27.13, p=≤ 0.0001). A combination of ≥17.2 g border zone mass and the presence of border zone channels on CMR was associated with subsequent ventricular arrhythmia in STEMI patients (OR 9.40; 95% CI 3.26-27.13; P≤0.0001).