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The relationship between the quantitative extent of late gadolinium enhancement and burden of nonsustained ventricular tachycardia in hypertrophic cardiomyopathy: A delayed contrast‐enhanced magnetic resonance study
Author(s) -
WeisslerSnir Adaya,
Hindieh Waseem,
Spears Danna A.,
Adler Ar,
Rakowski Harry,
Chan Raymond H.
Publication year - 2019
Publication title -
journal of cardiovascular electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.193
H-Index - 138
eISSN - 1540-8167
pISSN - 1045-3873
DOI - 10.1111/jce.13855
Subject(s) - medicine , cardiology , hypertrophic cardiomyopathy , ventricle , ejection fraction , ventricular tachycardia , cardiomyopathy , tachycardia , magnetic resonance imaging , sudden cardiac death , cardiac magnetic resonance imaging , atrial fibrillation , heart failure , radiology
Objectives To examine the relationship between late gadolinium enhancement (LGE) extent and nonsustained ventricular tachycardia (NSVT) characteristics in patients with hypertrophic cardiomyopathy (HCM). Background NSVT has been shown to be independently associated with sudden cardiac death (SCD) in HCM. Previous studies have found LGE on cardiac magnetic resonance (CMR) to be independently associated with NSVT. Methods Seventy‐three patients who had 14‐day Holter monitoring for either risk stratification for SCD (n = 62) or evaluation of atrial fibrillation (n = 11) on a CMR study were included. Areas of LGE in left ventricle (LV) were visually identified and analyzed quantitatively for both high (≥6 SD above the mean signal intensity of normal myocardium) and intermediate (≥4 but <6 SD) LGE signal intensity. Results Patients with more extensive LGE had longer ( P = 0.0028) and more frequent ( P = 0.02) episodes of NSVT. In univariate analyses, frequency of NSVT was associated with LGE extent ( r s = 0.43, P = 0.001), LV ejection fraction ( r s = −0.38, P < 0.001), LV mass ( r s = 0.32, P = 0.005), LV maximal wall thickness ( r s = 0.28, P = 0.016), and left atrium diameter ( r s = 0.29, P = 0.001); maximal length of NSVT was associated with LGE extent ( r s = 0.52, P < 0.001), LV ejection fraction ( r s = −0.44, P < 0.001), LV mass ( r s = 0.37, P = 0.001), and left atrium diameter ( r s = 0.3, P < 0.001). In multivariable analyses, LGE extent remained the sole variable independently associated with frequency ( P = 0.001) and maximal length of episodes of NSVT ( P = 0.001). No significant association was found between the rate of NSVT and LGE extent. Conclusions LGE extent is independently associated with a greater burden and longer episodes of NSVT in HCM. These findings support the association between myocardial fibrosis as represented by LGE and ventricular tachyarrhythmias in HCM.