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Left Ventricular Scar Burden Specifies the Potential for Ventricular Arrhythmogenesis: An LGE-CMR Study

Authors

  • PAUL A. SCOTT D.M., M.R.C.P.,

    1. Wessex Cardiothoracic Unit, Southampton University Hospitals NHS Trust, UK
    2. School of Medicine, University of Southampton, Southampton, UK
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  • JAMES A. ROSENGARTEN M.R.C.P.,

    1. Wessex Cardiothoracic Unit, Southampton University Hospitals NHS Trust, UK
    2. School of Medicine, University of Southampton, Southampton, UK
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  • DAVID C. MURDAY M.R.C.P.,

    1. Wessex Cardiothoracic Unit, Southampton University Hospitals NHS Trust, UK
    2. School of Medicine, University of Southampton, Southampton, UK
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  • CHARLES R. PEEBLES M.R.C.P., F.R.C.R.,

    1. Wessex Cardiothoracic Unit, Southampton University Hospitals NHS Trust, UK
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  • STEPHEN P. HARDEN M.A., F.R.C.R.,

    1. Wessex Cardiothoracic Unit, Southampton University Hospitals NHS Trust, UK
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  • NICK P. CURZEN Ph.D., F.R.C.P.,

    1. Wessex Cardiothoracic Unit, Southampton University Hospitals NHS Trust, UK
    2. School of Medicine, University of Southampton, Southampton, UK
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  • JOHN M. MORGAN M.D., F.R.C.P.

    1. Wessex Cardiothoracic Unit, Southampton University Hospitals NHS Trust, UK
    2. School of Medicine, University of Southampton, Southampton, UK
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  • This work was supported by an unrestricted educational grant from Medtronic.

  • P.A. Scott is supported by an educational grant from Medtronic. J.M. Morgan has received honoraria and research grants from Medtronic, St. Jude, Sorin, and Boston Scientific. D.C. Murday has previously been supported by unrestricted educational grants from Medtronic and Boston Scientific. N.P. Curzen has received honoraria and research grants from Boston Scientific, Medtronic, Cordis, Abbott Vascular, St. Jude Medical, Sorin, GSK, Haemonetics, AstraZeneca, Lilly, Schering-Plough, The Medicines Company, and Pfizer. Other authors: No disclosures.

Dr. P. A. Scott, Wessex Cardiothoracic Unit, Southampton University Hospital, Tremona Road, Southampton, SO16 6YD, United Kingdom. Fax: +44 02380 796614; E-mail: paul.andrew.scott@btinternet.com

Abstract

Late Gadolinium Enhancement and Arrhythmias. Introduction: The extent of left ventricular (LV) scar, characterized by late gadolinium enhancement cardiac MRI (LGE-CMR), has been shown to predict the occurrence of ventricular arrhythmias in implantable cardioverter defibrillator (ICD) recipients. However, the specificity of LGE-CMR for sudden cardiac death (SCD) versus non-SCD is unclear. The aim of this retrospective, observational study was to evaluate this relationship in a cohort of ICD recipients.

Methods and Results : We included consecutive patients who had undergone LGE-CMR before ICD implantation over a 4-year period (2006–2009). Scar (defined as myocardium with a signal intensity ≥50% of the maximum in scar tissue) was characterized in terms of percent scar and number of transmural LV scar segments in a 17-segment model. The endpoints were appropriate ICD therapy and all-cause mortality. Sixty-four patients (average age 66 ± 11 years, 51 male, median LVEF 30%) were included. During 42 ± 13 months follow-up, appropriate ICD therapy occurred in 28 patients (44%), and 14 patients (22%) died. Number of transmural scar segments (P = 0.005) and percentage LV scar (P = 0.03) were both significantly associated with appropriate ICD therapy. However, neither number of transmural scar segments (P = 0.32) or percent LV scar (P = 0.59) was significantly associated with all-cause mortality.

Conclusion : In this observational study, in medium-term follow-up, the extent of LV scar characterized by LGE-CMR was strongly associated with the occurrence of spontaneous ventricular arrhythmias but not all-cause mortality. We hypothesize that scar quantification by LGE-CMR may be more specific for SCD than non-SCD, and may prove a valuable tool for the selection of patients for ICD therapy. (J Cardiovasc Electrophysiol, Vol. 24, pp. 430-436, April 2013)

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