May 21, 2010Journal of Cardiovascular Magnetic ResonanceOpen Access

Extent of late gadolinium enhancement detected by cardiovascular magnetic resonance correlates with the inducibility of ventricular tachyarrhythmia in hypertrophic cardiomyopathy

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Hypertrophic cardiomyopathy (n=76). Intervention: Programmed ventricular stimulation (PVS) vs. No inducible ventricular tachyarrhythmias. Primary outcome: Percentage of LV mass with late gadolinium enhancement (LGE) in patients with vs without inducible VT (p=0.03).

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Key result

The extent of late gadolinium enhancement was significantly higher in hypertrophic cardiomyopathy patients with inducible ventricular tachyarrhythmias compared to those without (22% vs 10%, p=0.03).

Why the study?

Does the extent of late gadolinium enhancement on CMR correlate with the inducibility of ventricular tachyarrhythmias in patients with hypertrophic cardiomyopathy?

Population

76 consecutive patients with hypertrophic cardiomyopathy, including 43 classified as high-risk and 33…

Comparison

Assessment of myocardial fibrosis extent using… vs Patients with low clinical risk for sudden…

Design

Cohort

Authors

SFStephan FluechterInstitute of Cardiology JKJürgen KuschykElectrophysiology CWChristian WolpertUniversity of Stuttgart

Discussion

Member takes

Implication

LGE extent was associated with inducible VT in HCM; extends fibrosis-arrhythmia links but leaves SCD risk stratification utility open.

Key Points

To evaluate whether the extent of myocardial fibrosis quantified by late gadolinium-enhancement cardiovascular magnetic resonance correlates with the inducibility of ventricular tachyarrhythmias during programmed ventricular stimulation in hypertrophic cardiomyopathy.
Retrospectively analyzed 76 consecutive patients with hypertrophic cardiomyopathy, of whom 43 presented with clinical risk factors for sudden cardiac death and were categorized as high risk.
Assessed cardiovascular magnetic resonance parameters, quantifying late gadolinium enhancement as a percentage of left ventricular mass, and correlated results with electrophysiological testing in 38 high-risk patients.
High-risk patients had a higher prevalence (67% [29/43] vs 47% [14/33]; p = 0.03) and extent (14% vs 3% of left ventricular mass; p = 0.001) of late gadolinium enhancement compared to low-risk patients.
Among high-risk patients undergoing electrophysiological testing, those with inducible ventricular tachycardia demonstrated significantly greater late gadolinium enhancement extent than non-inducible patients (22% vs 10%; p = 0.03), while prevalence did not differ significantly (83% [10/12] vs 58% [15/26]; p = 0.12).
Multivariate analysis identified the extent of late gadolinium enhancement as the sole independent predictor of sudden cardiac death high-risk status (p = 0.03).

Study Design

Type

Observational (n=76)

Blinding

Blinded to EP findings

Multicenter

Structured PICO

Does the extent of late gadolinium enhancement on CMR correlate with the inducibility of ventricular tachyarrhythmias in patients with hypertrophic cardiomyopathy?

Population

76 consecutive patients with hypertrophic cardiomyopathy (HCM), including 43 classified as high-risk (≥1 risk factor for sudden cardiac death) and 33 classified as low-risk. 38 of the high-risk patients underwent electrophysiological testing.

Intervention

Assessment of myocardial fibrosis extent using late gadolinium-enhancement (LGE) cardiovascular magnetic resonance (CMR), measured as the % of LV mass with LGE.

Comparator

Patients with low clinical risk for sudden cardiac death, or high-risk patients without inducible ventricular tachyarrhythmias.

Outcome

Correlation between the extent of LGE (% of LV mass) and the inducibility of ventricular tachyarrhythmias (VT) during programmed ventricular stimulation, as well as the presence of risk factors for sudden cardiac death.surrogate

Main Result

Absolute Event Rate: 22% vs 10%

p-value: p=0.03

The extent of myocardial fibrosis measured by LGE on CMR correlates with the inducibility of ventricular tachyarrhythmias and clinical risk factors for sudden cardiac death in patients with hypertrophic cardiomyopathy.

Limitations

Retrospective observational study with a small sample size
Only patients clinically classified as high risk for sudden cardiac death were examined by EP, creating selection bias
Visual assessment was used to define the extent of LGE, for which there is currently no general consensus

Cite This Study

Fluechter et al. (2010) conducted an observational in Hypertrophic cardiomyopathy (n=76). Programmed ventricular stimulation (PVS) vs. No inducible ventricular tachyarrhythmias was evaluated on Percentage of LV mass with late gadolinium enhancement (LGE) in patients with vs without inducible VT (p=0.03). The extent of late gadolinium enhancement was significantly higher in hypertrophic cardiomyopathy patients with inducible ventricular tachyarrhythmias compared to those without (22% vs 10%, p=0.03).

synapsesocial.com/papers/6a0efe69aa1655e5fb231c66 https://doi.org/10.1186/1532-429x-12-30

Topics

Ventricular arrhythmias Hypertrophic cardiomyopathy

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Extent of late gadolinium enhancement detected by cardiovascular magnetic resonance correlates with the inducibility of ventricular tachyarrhythmia in hypertrophic cardiomyopathy

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

Topics

Extent of late gadolinium enhancement detected by cardiovascular magnetic resonance correlates with the inducibility of ventricular tachyarrhythmia in hypertrophic cardiomyopathy

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

Also Consider

Topics

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