Email this article Characteristic of fibrotic myocardial lesions associated with life-threatening ventricular tachyarrhythmias in patients with ischemic and non-ischemic cardiomyopathies
- Authors: Shlevkov NB1, Zhambeev AA1, Gasparyan AZ1, Shitov VN1, Stukalova OV1
-
Affiliations:
- Department of clinical electrophysiology and roentgenosurgical methods of treatment of cardiac arrhythmias. National Medical Research Cardiology Center
- Issue: Vol 90, No 9 (2018)
- Pages: 42-47
- Section: Editorial
- URL: https://journal-vniispk.ru/0040-3660/article/view/32988
- DOI: https://doi.org/10.26442/terarkh201890942-47
- ID: 32988
Cite item
Full Text
Abstract
Aim. To identify the features of myocardial scar and fibrosis associated with the occurrence of malignant ventricular tachyarrhythmias (VTs) in high-risk patients with ischemic (ICMP) and non-ischemic cardiomyopathy (NICMP). Materials and methods. This prospective study included 50 patients (41 men, 9 women), age = 60 ± 13 years, 30 patients of them with ICMP and 20 patients with NICMP, who underwent echocardiography (Echo) and contrast magnetic resonance imaging (MRI) of the heart followed by implantation of cardioverter-defibrillators (ICD) or resynchronizing devices with defibrillator (CPTD) to prevent sudden cardiac death. Results. Sustained VTs were reported in 20/30 (67%) patients with ICMP and in 5/20 (25%) patients with NICMP on follow-up [26 (22-37) months]. Successive univariate and ROC-analyses of Echo and MRI-indices between patients with and without recurrence of VTs found different results for ICMP and NICMP patients groups. In ICMP patients the VTs were associated with wide transmural fibrosis on contrast MRI that covered 3 or more segments of left ventricular. These segments were preferably localized in the middle parts of the inferior and inferolateral segments of the left ventricle. The independent predictors of VTs in NICMP patients were non-transmural fibrosis at 4.5% of the left ventricular mass by contrast MRI as well as low left ventricular ejection fraction (less than 26%) by Echo. Conclusion. To determine the indications for implantation of the ICD and CRTD for primary prevention of sudden cardiac death, it is advisable to take into account not only the value of ejection fraction of left ventricular, but also the features of the fibrosis of the left ventricle by contrast MRI of the heart.
Full Text
##article.viewOnOriginalSite##About the authors
N B Shlevkov
Department of clinical electrophysiology and roentgenosurgical methods of treatment of cardiac arrhythmias. National Medical Research Cardiology Center
Email: nik.shlevkov@inbox.ru
к.м.н., с.н.с. отд. клинической электрофизиологии и рентгенохирургических методов лечения нарушений ритма сердца Moscow, Russia
A A Zhambeev
Department of clinical electrophysiology and roentgenosurgical methods of treatment of cardiac arrhythmias. National Medical Research Cardiology Centerаспирант отд. клинической электрофизиологии и рентгенохирургических методов лечения нарушений ритма сердца Moscow, Russia
A Z Gasparyan
Department of clinical electrophysiology and roentgenosurgical methods of treatment of cardiac arrhythmias. National Medical Research Cardiology Centerаспирант отд. клинической электрофизиологии и рентгенохирургических методов лечения нарушений ритма сердца Moscow, Russia
V N Shitov
Department of clinical electrophysiology and roentgenosurgical methods of treatment of cardiac arrhythmias. National Medical Research Cardiology Centerм.н.с. отд. ультразвуковых методов исследования Moscow, Russia
O V Stukalova
Department of clinical electrophysiology and roentgenosurgical methods of treatment of cardiac arrhythmias. National Medical Research Cardiology Centerк.м.н., с.н.с. отд. томографии Moscow, Russia
References
- Velasco A, Stirrup J, Reyes E, Hage F.G. Guidelines in review: Comparison between AHA/ACC and ESC guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. J Nucl Cardiol. 2017;24:1893-901.
- Qu Z, Weiss J.N. Mechanisms of ventricular arrhythmias: from molecular fluctuations to electrical turbulence. Annu Rev Physiol. 2015; 1-32.
- Waks J.W, Buxton A.E. Risk stratification for sudden cardiac death after myocardial infarction. Annu Rev Med. 2018;69:147-64.
- Бокерия Л.А., Ревишвили А.Ш., Неминущий Н.М. Внезапная сердечная смерть. М.: ГЭОТАР-Медиа, 2011; 267 с.
- Santangeli P, Epstein A.E. Sudden cardiac death: lessons learned from cardiac implantable rhythm devices. Card Electrophysiol Clin. 2017;9:749-59.
- Priori S.G, Blomström-Lundqvist C, Mazzanti A, et al. 2015 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: The Task Force for the Management of Patients with Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death of the European Society of Cardiology (ESC). Europace. 2015;17:1601-87.
- Yan А, Shayne А, Brown К, et al. Characterization of the peri - infarct zone by contrast - enhanced cardiac magnetic resonance imaging is a powerful predictor of post - myocardial infarction mortality. Circulation. 2006;114: 32-9.
- Синицын В.Е., Мершина Е.А., Ларина О.М. Возможности магнитно - резонансной томографии и в диагностике кардиомиопатии. Клин. и эксперимент. хир. журнал им. акад. Б.В. Петровского. 2014;1:54-63.
- Стукалова О.В. Магнитно - резонансная томография сердца с отсроченным контрастированием - новый метод диагностики заболеваний сердца. REJR. 2013; 3:7-17.
- Cerqueira M.D, Weissman N.J, Dilsizian V, et al. Standardized myocaardial segmentation and nomenclature for tomographic imaging of the heart. A statement for healthcare professionals from the Cardiac Imaging Committee of the Council on Clinical Cardiology of the American Heart Association. Circulation. 2002;105(4):539-42.
- Lang R.M, Bierig M, Devereux R.B. Recommendations for Chamber Quantification: A Report from the American Society of Echocardiographys Guidelines and Standards Committee and the Chamber Quantification Writing Group, Developed in Conjunction with the European Society of Echocardiography. J Am Soc Echocardiogr. 2005;18(12):1440-63.
- Lown B, Wolf M. Approaches to sudden death from coronarheart disease. Circulation. 1971;44:130-42.
- Lown B. Sudden cardiac death: biobehavioral perspective. Circulation. 1987;76:1186-96.
- Yoshiga Y, Mathew S, Wissner E, et al. Correlation between substrate location and ablation strategy in patients with ventricular tachycardia late after myocardial infarction. Heart Rhythm. 2012;9:1192-9. doi: 10.1016/j.hrthm.2012.03.058
- Culic V. Inferior myocardial infarction scars could be more arrhythmogenic than anterior ones. Europace. 2010;12:597. doi: 10.1093/europace/eup445
- Lacroix D, Warembourg H, Klug D, et al. Intraoperative computerized mapping of ventricular tachycardia: differences between anterior and inferior myocardial infarctions. J Cardiovasc Electrophysiol. 1999;10:781-90.
- Køber L, Thune J.J, Nielsen J.C, Haarbo J, et al. DANISH Investigators. Defibrillator Implantation in Patients with Nonischemic Systolic Heart Failure. N Engl J Med. 2016;375:1221-30.
Supplementary files
