0141: Value of cardiac magnetic resonance imaging to predict the occurrence of ventricular tachycardia in post-infarct patients - 07/02/15
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Résumé |
Introduction |
The use of implantable cardioverter-defibrillators (ICD) is recommended to prevent sudden cardiac death (SCD) in patients with a reduced (≤30-35%) left ventricular ejection fraction (LVEF) due to previous myocardial infarction (MI). Some patients, however, never receive adequate ICD intervention. We studied whether the characteristics of MI
scar, as assessed by magnetic resonance imaging (MRI), could predict the occurrence of ventricular tachycardia (VT).
Methods |
Fifty-one patients (41 men, mean age=59±11 years) with a remote (>6 months) MI and a class I primary prevention indication for ICD implantation underwent a cardiac MRI study before implantation. Delayed contrast enhancement (DCE) was used to delineate post-MI scars.On the basis of manually outlined contours of left ventricular epicardial, endocardial and scar borders, the location and transmural extent of the scar were calculated.
Results |
VT occurred in 15 patients (29%) after a follow-up of 43±24 months. There were no statistical differences between patients who experienced VT and those who did not for demographic data, LVEF, total myocardial and MI surface. At infarct borders, MRI showed areas with intramural and/or epicardial scar in all but one patients. Epicardial scar surface (3.6±0.5 vs. 1.4±0.3 cm2; p=0.0005) and intramural scar surface (4.0±0.6 vs. 1.8±0.4 cm2; p=0.002) were greater in patients with VT. In multivariate analysis, intramural and sub-epicardial scar surface remained significantly associated with the occurrence of VT (respectively: HR, 1.28/1cm2; CI, 1.10 to 1.51; p=0.003 and HR, 1.23/1cm2; CI, 1.01 to 1.51; p=0.04). Patients with intramural scar surface>1.65 cm2 had lower 5 years VT free survival (33.8% vs. 100%; p<0.0001).
Conclusion |
The presence of a critical surface of both intramural and epicardial scars at an infarct border may be key factors for the occurrence of VT after MI.
Abstract 0141 - Figure: 3D left ventricular reconstruction
Abstract 0141 - Figure: 3D left ventricular reconstructionLe texte complet de cet article est disponible en PDF.
Plan
Vol 7 - N° 1
P. 64-65 - janvier 2015 Retour au numéro
Article précédent
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- Damien Voilliot, Freddy Odille, Damien Mandry, Marius Andronache, Olivier Huttin, Isabelle Magnin-Poull, Jean-Marc Sellal, Arnaud Olivier, Vladimir Manenti, Beatrice Brembilla-Perrot, Hugues Blangy, Jacques Felblinger, Pierre-Yves Marie, Etienne Aliot, Nicolas Sadoul, Christian De Chillou
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