doi: 10.1161/CIRCULATIONAHA.105.549659
(Circulation. 2005;112:2821-2825.)
© 2005 American Heart Association, Inc.
Imaging |
Magnetic Resonance Assessment of the Substrate for Inducible Ventricular Tachycardia in Nonischemic Cardiomyopathy
From Johns Hopkins Hospital, Departments of Medicine/Cardiology (S.N., D.A.B., A.C.L., M.M.Z., S.P.W., T.L.D., G.R.M., A.R., H.C., G.F.T., R.G.W., R.D.B., J.A.C.L., H.R.H.), Radiology (D.A.B, J.A.C.L., H.R.H.), Biomedical Engineering (A.C.L., H.R.H.), and Surgery (A.C.L.), Baltimore, Md.
Correspondence to Saman Nazarian, Division of Cardiology, Johns Hopkins Hospital, Carnegie 568, 600 N Wolfe St, Baltimore, MD 21287. E-mail snazari1{at}jhmi.edu
Received March 22, 2005; revision received August 2, 2005; accepted August 8, 2005.
Background— Patients with left ventricular dysfunction have an elevated risk of sudden cardiac death. However, the substrate for ventricular arrhythmia in patients with nonischemic cardiomyopathy remains poorly understood. We hypothesized that the distribution of scar identified by MRI is predictive of inducible ventricular tachycardia.
Methods and Results— Short-axis cine steady-state free-precession and postcontrast inversion-recovery gradient-echo MRI sequences were obtained before electrophysiological study in 26 patients with nonischemic cardiomyopathy. Left ventricular ejection fraction was measured from end-diastolic and end-systolic cine images. The transmural extent of scar as a percentage of wall thickness (percent scar transmurality) in each of 12 radial sectors per slice was calculated in all myocardial slices. The percentages of sectors with 1% to 25%, 26% to 50%, 51% to 75%, and 76% to 100% scar transmurality were determined for each patient. Predominance of scar distribution involving 26% to 75% of wall thickness was significantly predictive of inducible ventricular tachycardia and remained independently predictive in the multivariable model after adjustment for left ventricular ejection fraction (odds ratio, 9.125; P=0.020).
Conclusions— MR assessment of scar distribution can identify the substrate for inducible ventricular tachycardia and may identify high-risk patients with nonischemic cardiomyopathy currently missed by ejection fraction criteria.
Key Words: electrophysiology • magnetic resonance imaging • tachyarrhythmias
Related Article:
Circulation 2005 112: 2753.
This article has been cited by other articles:
 |
|
 |
|
  T. D. Karamitsos, J. M. Francis, S. Myerson, J. B. Selvanayagam, and S. Neubauer The Role of Cardiovascular Magnetic Resonance Imaging in Heart Failure J. Am. Coll. Cardiol., October 6, 2009; 54(15): 1407 - 1424. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Ghio, M. Revera, F. Mori, C. Klersy, A. Raisaro, C. Raineri, A. Serio, M. Pasotti, and L. O. Visconti Regional abnormalities of myocardial deformation in patients with hypertrophic cardiomyopathy: correlations with delayed enhancement in cardiac magnetic resonance Eur J Heart Fail, October 1, 2009; 11(10): 952 - 957. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 B. Takase and M. Nagata Delayed Enhancement Morphology on Cardiac Magnetic Resonance Imaging is Correlated With Signal-averaged Electrocardiogram and QT Dispersion in Myocardial Infarction Angiology, August 1, 2009; 60(4): 412 - 418. [Abstract] [PDF]
|
|
|
|
 |
|
 E. M. Aliot, W. G. Stevenson, J. M. Almendral-Garrote, F. Bogun, C. H. Calkins, E. Delacretaz, P. D. Bella, G. Hindricks, P. Jais, M. E. Josephson, et al. EHRA/HRS Expert Consensus on Catheter Ablation of Ventricular Arrhythmias: Developed in a partnership with the European Heart Rhythm Association (EHRA), a Registered Branch of the European Society of Cardiology (ESC), and the Heart Rhythm Society (HRS); in collaboration with the American College of Cardiology (ACC) and the American Heart Association (AHA) Europace, June 1, 2009; 11(6): 771 - 817. [Full Text] [PDF]
|
|
|
|
 |
|
 S. D. Roes, C. J. W. Borleffs, R. J. van der Geest, J. J.M. Westenberg, N. A. Marsan, T. A.M. Kaandorp, J. H.C. Reiber, K. Zeppenfeld, H. J. Lamb, A. de Roos, et al. Infarct Tissue Heterogeneity Assessed With Contrast-Enhanced MRI Predicts Spontaneous Ventricular Arrhythmia in Patients With Ischemic Cardiomyopathy and Implantable Cardioverter-Defibrillator Circ Cardiovasc Imaging, May 1, 2009; 2(3): 183 - 190. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. J. Sparrow, N. Merchant, Y. L. Provost, D. J. Doyle, E. T. Nguyen, and N. S. Paul CT and MR Imaging Findings in Patients with Acquired Heart Disease at Risk for Sudden Cardiac Death1 RadioGraphics, May 1, 2009; 29(3): 805 - 823. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. M. Bogun, B. Desjardins, E. Good, S. Gupta, T. Crawford, H. Oral, M. Ebinger, F. Pelosi, A. Chugh, K. Jongnarangsin, et al. Delayed-enhanced magnetic resonance imaging in nonischemic cardiomyopathy utility for identifying the ventricular arrhythmia substrate. J. Am. Coll. Cardiol., March 31, 2009; 53(13): 1138 - 1145. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Rolf, W. Haverkamp, M. Borggrefe, G. Breithardt, and D. Bocker Induction of ventricular fibrillation rather than ventricular tachycardia predicts tachyarrhythmia recurrences in patients with idiopathic dilated cardiomyopathy and implantable cardioverter defibrillator for secondary prophylaxis Europace, March 1, 2009; 11(3): 289 - 296. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 B. A. Koplan and W. G. Stevenson Ventricular Tachycardia and Sudden Cardiac Death Mayo Clin. Proc., March 1, 2009; 84(3): 289 - 297. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Nazarian, D. A. Bluemke, and H. R. Halperin Applications of Cardiac Magnetic Resonance in Electrophysiology Circ Arrhythm Electrophysiol, February 1, 2009; 2(1): 63 - 71. [Full Text] [PDF]
|
|
|
|
|
|
K. W. Cummings, S. Bhalla, C. Javidan-Nejad, A. J. Bierhals, F. R. Gutierrez, and P. K. Woodard A Pattern-based Approach to Assessment of Delayed Enhancement in Nonischemic Cardiomyopathy at MR Imaging1 RadioGraphics, January 1, 2009; 29(1): 89 - 103. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. G. Strauss, R. H. Selvester, J. A.C. Lima, H. Arheden, J. M. Miller, G. Gerstenblith, E. Marban, R. G. Weiss, G. F. Tomaselli, G. S. Wagner, et al. ECG Quantification of Myocardial Scar in Cardiomyopathy Patients With or Without Conduction Defects: Correlation With Cardiac Magnetic Resonance and Arrhythmogenesis Circ Arrhythm Electrophysiol, December 1, 2008; 1(5): 327 - 336. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. P. Piccini, J. R. Horton, L. K. Shaw, S. M. Al-Khatib, K. L. Lee, A. E. Iskandrian, and S. Borges-Neto Single-Photon Emission Computed Tomography Myocardial Perfusion Defects Are Associated With an Increased Risk of All-Cause Death, Cardiovascular Death, and Sudden Cardiac Death Circ Cardiovasc Imaging, November 1, 2008; 1(3): 180 - 188. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. R. Halperin and S. Nazarian Damage Assessment After Ablation: Role of Cardiovascular Magnetic Resonance J. Am. Coll. Cardiol., October 7, 2008; 52(15): 1272 - 1273. [Full Text] [PDF]
|
|
|
|
|
|
J. J. Goldberger, M. E. Cain, S. H. Hohnloser, A. H. Kadish, B. P. Knight, M. S. Lauer, B. J. Maron, R. L. Page, R. S. Passman, D. Siscovick, et al. American Heart Association/American College of Cardiology Foundation/Heart Rhythm Society Scientific Statement on Noninvasive Risk Stratification Techniques for Identifying Patients at Risk for Sudden Cardiac Death: A Scientific Statement From the American Heart Association Council on Clinical Cardiology Committee on Electrocardiography and Arrhythmias and Council on Epidemiology and Prevention J. Am. Coll. Cardiol., September 30, 2008; 52(14): 1179 - 1199. [Full Text] [PDF]
|
|
|
|
 |
|
 J. J. Goldberger, M. E. Cain, S. H. Hohnloser, A. H. Kadish, B. P. Knight, M. S. Lauer, B. J. Maron, R. L. Page, R. S. Passman, D. Siscovick, et al. American Heart Association/American College of Cardiology Foundation/Heart Rhythm Society Scientific Statement on Noninvasive Risk Stratification Techniques for Identifying Patients at Risk for Sudden Cardiac Death: A Scientific Statement From the American Heart Association Council on Clinical Cardiology Committee on Electrocardiography and Arrhythmias and Council on Epidemiology and Prevention Circulation, September 30, 2008; 118(14): 1497 - 1518. [Full Text] [PDF]
|
|
|
|
 |
|
 M. S. Maron, E. Appelbaum, C. J. Harrigan, J. Buros, C. M. Gibson, C. Hanna, J. R. Lesser, J. E. Udelson, W. J. Manning, and B. J. Maron Clinical Profile and Significance of Delayed Enhancement in Hypertrophic Cardiomyopathy Circ Heart Fail, September 1, 2008; 1(3): 184 - 191. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Nazarian, A. Kolandaivelu, M. M. Zviman, G. R. Meininger, R. Kato, R. C. Susil, A. Roguin, T. L. Dickfeld, H. Ashikaga, H. Calkins, et al. Feasibility of Real-Time Magnetic Resonance Imaging for Catheter Guidance in Electrophysiology Studies Circulation, July 15, 2008; 118(3): 223 - 229. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. C. Wu, R. G. Weiss, D. R. Thiemann, K. Kitagawa, A. Schmidt, D. Dalal, S. Lai, D. A. Bluemke, G. Gerstenblith, E. Marban, et al. Late gadolinium enhancement by cardiovascular magnetic resonance heralds an adverse prognosis in nonischemic cardiomyopathy. J. Am. Coll. Cardiol., June 24, 2008; 51(25): 2414 - 2421. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. S. Adabag, B. J. Maron, E. Appelbaum, C. J. Harrigan, J. L. Buros, C. M. Gibson, J. R. Lesser, C. A. Hanna, J. E. Udelson, W. J. Manning, et al. Occurrence and Frequency of Arrhythmias in Hypertrophic Cardiomyopathy in Relation to Delayed Enhancement on Cardiovascular Magnetic Resonance J. Am. Coll. Cardiol., April 8, 2008; 51(14): 1369 - 1374. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Nazarian and J. A.C. Lima Cardiovascular Magnetic Resonance for Risk Stratification of Arrhythmia in Hypertrophic Cardiomyopathy J. Am. Coll. Cardiol., April 8, 2008; 51(14): 1375 - 1376. [Full Text] [PDF]
|
|
|
|
 |
|
 W. Jung and B. Schumacher What is the role of risk stratification for sudden death in the defibrillator era? Eur. Heart J. Suppl., December 1, 2007; 9(suppl_I): I59 - I65. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 V. R. S. Fernandes, K. C. Wu, B. D. Rosen, A. Schmidt, A. C. Lardo, N. Osman, H. R. Halperin, G. Tomaselli, R. Berger, D. A. Bluemke, et al. Enhanced Infarct Border Zone Function and Altered Mechanical Activation Predict Inducibility of Monomorphic Ventricular Tachycardia in Patients with Ischemic Cardiomyopathy Radiology, December 1, 2007; 245(3): 712 - 719. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H. Ashikaga, T. Sasano, J. Dong, M. M. Zviman, R. Evers, B. Hopenfeld, V. Castro, R. H. Helm, T. Dickfeld, S. Nazarian, et al. Magnetic Resonance Based Anatomical Analysis of Scar-Related Ventricular Tachycardia: Implications for Catheter Ablation Circ. Res., October 26, 2007; 101(9): 939 - 947. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. P. Lim, M. B. Srichai, and V. S. Lee Non-Ischemic Causes of Delayed Myocardial Hyperenhancement on MRI Am. J. Roentgenol., June 1, 2007; 188(6): 1675 - 1681. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
W. G. Stevenson and K. Soejima Catheter Ablation for Ventricular Tachycardia Circulation, May 29, 2007; 115(21): 2750 - 2760. [Full Text] [PDF]
|
|
|
|
|
|
C. M. Kramer The Expanding Prognostic Role of Late Gadolinium Enhanced Cardiac Magnetic Resonance J. Am. Coll. Cardiol., November 21, 2006; 48(10): 1986 - 1987. [Full Text] [PDF]
|
|
|
|
|
|
R. G. Assomull, S. K. Prasad, J. Lyne, G. Smith, E. D. Burman, M. Khan, M. N. Sheppard, P. A. Poole-Wilson, and D. J. Pennell Cardiovascular Magnetic Resonance, Fibrosis, and Prognosis in Dilated Cardiomyopathy J. Am. Coll. Cardiol., November 21, 2006; 48(10): 1977 - 1985. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. J. Klocke, E. Wu, and D. C. Lee "Shades of Gray" in Cardiac Magnetic Resonance Images of Infarcted Myocardium: Can They Tell Us What We'd Like Them to? Circulation, July 4, 2006; 114(1): 8 - 10. [Full Text] [PDF]
|
|
|
|
|
|
A. T. Yan, A. J. Shayne, K. A. Brown, S. N. Gupta, C. W. Chan, T. M. Luu, M. F. Di Carli, H. G. Reynolds, W. G. Stevenson, and R. Y. Kwong Characterization of the Peri-Infarct Zone by Contrast-Enhanced Cardiac Magnetic Resonance Imaging Is a Powerful Predictor of Post-Myocardial Infarction Mortality Circulation, July 4, 2006; 114(1): 32 - 39. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. E. Marchlinski and M. Jessup Timing the Implantation of Implantable Cardioverter-Defibrillators in Patients With Nonischemic Cardiomyopathy J. Am. Coll. Cardiol., June 20, 2006; 47(12): 2483 - 2485. [Full Text] [PDF]
|
|