Scar extent evaluated by late gadolinium enhancement CMR: a powerful predictor of long term appropriate ICD therapy in patients with coronary artery disease

Journal of Cardiovascular Magnetic Resonance

Research

Audrey Emmanuelle Dugué¹  Patrice Scanu²  Joachim Alexandre²  Adrien Lemaitre²  Fabien Labombarda²  Sophie Gomes²  Alain Lebon³  Vincent Roule³  Paul Milliez³  Eric Saloux³  Nicole Provost⁴ 

[1] Department of biostatistics and clinical research, CHU de Caen, F-14000, Caen, France;Université de Caen Basse-Normandie, Medical School, F-14000, Caen, France;Department of cardiology, CHU de Caen, Avenue de la Côte de Nacre, F-14000, Caen, France;Department of cardiology, CHU de Caen, Avenue de la Côte de Nacre, F-14000, Caen, France;Université de Caen Basse-Normandie, Medical School, F-14000, Caen, France;Department of radiology, CHU de Caen, F-14000, Caen, France;

关键词: Implantable cardioverter-defibrillator;    Cardiovascular magnetic resonance;    Scar tissue;    Coronary artery disease;    Sudden cardiac death;    Ventricular arrhythmias;   

DOI  :  10.1186/1532-429X-15-12

 received in 2012-12-16, accepted in 2013-01-03,  发布年份 2013

来源: Springer

【 摘 要 】

BackgroundCoronary artery disease (CAD) patients are at risk for life-threatening ventricular arrhythmias (VA) related to scar tissue. Late gadolinium enhancement cardiovascular magnetic resonance (LGE-CMR) can accurately identify myocardial scar extent. It has been shown that scar extent, particularly scar transmurality, percent scar and scar mass, are associated with the occurrence of appropriate implantable cardioverter-defibrillator (ICD) therapy. However, quantification of transmurality extent has never been studied. The purpose of our study was to evaluate whether different methods quantifying scar transmurality, percent scar and scar mass (assessed with LGE-CMR) can predict appropriate ICD therapy in CAD patients with a long term follow-up period.Methods and resultsWe enrolled retrospectively 66 patients with chronic CAD referred for primary or secondary preventive ICD implantation and LGE-CMR before ICD implantation. Using LGE-CMR, scar extent was assessed by measuring scar mass, percent scar and transmural scar extent using four different methods. The median follow-up duration was 41.5 months (interquartile range 22–52). The endpoint was the occurrence of appropriate device therapy and occurred in 14 patients. Pre-ICD revascularization and transmural scar extent were significantly associated with the study endpoint but the latter was especially highly dependent on the method used. Patients with appropriate device therapy had also larger scar mass (29.6 ± 14.5 g vs 17.1 ± 8.8 g, p = 0.004), and larger percent scar (15.1 ± 8.2% vs 9.9 ± 5.6%, p = 0.03) than patients without appropriate device therapy. In multivariate analysis, scar extent variables remained significantly associated with the study end-point.ConclusionsIn this study of CAD patients implanted for primary or secondary preventive ICD, pre-ICD revascularization and scar extent studied by LGE-CMR were significantly associated with appropriate device therapy and can identify a subgroup of CAD patients with an increased risk of life-threatening VA. Depending of the method used, transmural scar extent may vary significantly and needs further studies to obtain a validated and consensual study method.

【 授权许可】

CC BY   
© Alexandre et al.; licensee BioMed Central Ltd. 2013