Infarct morphology identifies patients with substrate for sustained ventricular tachycardia

David Bello, David S. Fieno, Raymond J. Kim, F. Scott Pereles, Rod Passman, Gina Song, Alan H. Kadish, Jeffrey J. Goldberger

Research output: Contribution to journalArticle

356 Scopus citations

Abstract

OBJECTIVES: We sought to evaluate whether infarct size characterization by cardiac magnetic resonance imaging (MRI) is a better predictor of inducible ventricular tachycardia (VT) than left ventricular ejection fraction (LVEF). BACKGROUND: Inducibility of VT at electrophysiologic study (EPS) and low LVEF can identify patients with a substrate for VT. Magnetic resonance imaging has been shown to identify, with high precision, areas of myocardial infarction and may therefore be a better tool to evaluate for a substrate for VT. METHODS: We studied 48 patients with known coronary artery disease who were referred for EPS using cine and gadolinium-enhanced MRI. Wall motion and infarct characteristics were determined blindly and compared among patients with no inducible ventricular arrhythmias (n = 21), those with inducible monomorphic VT (MVT, n = 18), and those with either inducible polymorphic VT or ventricular fibrillation (n = 9). RESULTS: Patients with MVT had larger infarcts than patients who did not have inducible arrhythmias (mass: 49 ± 5 g [SE] vs. 28 ± 5 g, p < 0.005; surface area: 172 ± 15 cm2 vs. 93 ± 14 cm2, p < 0.0005). Patients with polymorphic VT/fibrillation had intermediate values (mass: 36 ± 7 g; surface area: 115 ± 22 cm2). Ejection fraction was inversely related to infarct mass and surface area, with R2 values ranging from 0.21 to 0.27. Logistic regression and receiver-operating characteristic analysis demonstrated that infarct mass and surface area were better predictors of inducibility of MVT than LVEF. CONCLUSIONS: Infarct surface area and mass, as measured by cardiac MRI, are better identifiers of patients who have a substrate for MVT than LVEF. Further evaluation of infarct size characterization by cardiac MRI as a predictor of sudden cardiac death is warranted.

Original languageEnglish (US)
Pages (from-to)1104-1108
Number of pages5
JournalJournal of the American College of Cardiology
Volume45
Issue number7
DOIs
StatePublished - Apr 1 2005
Externally publishedYes

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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