Diffuse Ventricular Fibrosis on Cardiac Magnetic Resonance Imaging Associates with Ventricular Tachycardia in Patients with Hypertrophic Cardiomyopathy

Alex J.A. McLellan, Andris H. Ellims, Sandeep Prabhu, Alex Voskoboinik, Leah M. Iles, James L. Hare, David M. Kaye, Ivan Macciocca, Justin A. Mariani, Jonathan M. Kalman, Andrew J. Taylor, Peter M. Kistler

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27 Citations (Scopus)

Abstract

Diffuse Fibrosis Predicts Ventricular Arrhythmia in HCM Introduction Non-sustained ventricular tachycardia (NSVT) is a risk factor for sudden cardiac death (SCD) in patients with hypertrophic cardiomyopathy (HCM). We aimed to assess whether diffuse ventricular fibrosis on cardiac magnetic resonance (CMR) imaging could be a surrogate marker for ventricular arrhythmias in patients with HCM. Methods A total of 100 patients with HCM (mean age 51 ± 13 years, septal wall thickness 20 ± 5 mm) underwent CMR with a 1.5 T scanner to determine the presence of ventricular late gadolinium enhancement (LGE) for focal fibrosis, and post-contrast T1 mapping for diffuse ventricular fibrosis. The presence of NSVT was determined by Holter monitoring and a subset of high risk patients received an implantable cardioverter-defibrillator (ICD). Results NSVT was detected in 23 of 100 patients with HCM. Focal ventricular fibrosis (by LGE) was observed in 87%, with no significant difference between patients with (96%) or without NSVT (86%, P = 0.19). However, LGE mass was greater in patients with (16.5 ± 19.1 g) versus without NSVT (7.6 ± 10.2 g, P < 0.01). NSVT was associated with a significant reduction in ventricular T1 relaxation time (422 ± 54 milliseconds) versus patients without NSVT (512 ± 115 milliseconds; P < 0.001). There was significant reduction in ventricular T1 relaxation time in patients with (430 ± 48 milliseconds) versus without aborted SCD (495 ± 113 milliseconds; P = 0.01) over a mean follow-up of 40 ± 10 months. On multivariate analysis post-contrast ventricular T1 relaxation time and septal wall thickness were the only predictors of NSVT. Conclusion Post-contrast T1 relaxation time on CMR is associated with ventricular arrhythmias in patients with HCM. Diffuse ventricular fibrosis may be an important marker of arrhythmic risk in patients with HCM.

Original languageEnglish
Pages (from-to)571-580
Number of pages10
JournalJournal of Cardiovascular Electrophysiology
Volume27
Issue number5
DOIs
Publication statusPublished - May 2016
Externally publishedYes

Keywords

  • cardiac magnetic resonance
  • hypertrophic cardiomyopathy
  • implantable cardioverter defibrillator
  • MRI
  • myocardial fibrosis
  • ventricular tachycardia

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