Infarct tissue heterogeneity by magnetic resonance imaging identifies enhanced cardiac arrhythmia susceptibility in patients with left ventricular dysfunction

André Schmidt, Clerio F. Azevedo, Alan Cheng, Sandeep N. Gupta, David A. Bluemke, Thomas K. Foo, Gary Gerstenblith, Robert G. Weiss, Eduardo Marbán, Gordon F. Tomaselli, João A C Lima, Katherine C. Wu

Research output: Contribution to journalArticle

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Abstract

BACKGROUND - The extent of the peri-infarct zone by magnetic resonance imaging (MRI) has been related to all-cause mortality in patients with coronary artery disease. This relationship may result from arrhythmogenesis in the infarct border. However, the relationship between tissue heterogeneity in the infarct periphery and arrhythmic substrate has not been investigated. In the present study, we quantify myocardial infarct heterogeneity by contrast-enhanced MRI and relate it to an electrophysiological marker of arrhythmic substrate in patients with left ventricular (LV) systolic dysfunction undergoing prophylactic implantable cardioverter defibrillator placement. METHODS AND RESULTS - Before implantable cardioverter defibrillator implantation for primary prevention of sudden cardiac death, 47 patients underwent cine and contrast-enhanced MRI to measure LV function, volumes, mass, and infarct size. A method for quantifying the heterogeneous infarct periphery and the denser infarct core is described. MRI indices were related to inducibility of sustained monomorphic ventricular tachycardia during electrophysiological or device testing. For the noninducible versus inducible patients, LV ejection fraction (30±10% versus 29±7%, P=0.79), LV end-diastolic volume (220±70 versus 228±57 mL, P=0.68), and infarct size by standard contrast-enhanced MRI definitions (P=NS) were similar. Quantification of tissue heterogeneity at the infarct periphery was strongly associated with inducibility for monomorphic ventricular tachycardia (noninducible versus inducible: 13±9 versus 19±8 g, P=0.015) and was the single significant factor in a stepwise logistic regression. CONCLUSIONS - Tissue heterogeneity is present and quantifiable within human infarcts. More extensive tissue heterogeneity correlates with increased ventricular irritability by programmed electrical stimulation. These findings support the hypothesis that anatomic tissue heterogeneity increases susceptibility to ventricular arrhythmias in patients with prior myocardial infarction and LV dysfunction.

Original languageEnglish (US)
Pages (from-to)2006-2014
Number of pages9
JournalCirculation
Volume115
Issue number15
DOIs
StatePublished - Apr 1 2007
Externally publishedYes

Fingerprint

Left Ventricular Dysfunction
Cardiac Arrhythmias
Magnetic Resonance Imaging
Implantable Defibrillators
Ventricular Tachycardia
Stroke Volume
Myocardial Infarction
Sudden Cardiac Death
Primary Prevention
Left Ventricular Function
Electric Stimulation
Coronary Artery Disease
Logistic Models
Equipment and Supplies
Mortality

Keywords

  • Arrhythmia
  • Cardiomyopathy
  • Diagnosis
  • Imaging
  • Magnetic resonance imaging
  • Myocardial infarction

ASJC Scopus subject areas

  • Medicine(all)
  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Infarct tissue heterogeneity by magnetic resonance imaging identifies enhanced cardiac arrhythmia susceptibility in patients with left ventricular dysfunction. / Schmidt, André; Azevedo, Clerio F.; Cheng, Alan; Gupta, Sandeep N.; Bluemke, David A.; Foo, Thomas K.; Gerstenblith, Gary; Weiss, Robert G.; Marbán, Eduardo; Tomaselli, Gordon F.; Lima, João A C; Wu, Katherine C.

In: Circulation, Vol. 115, No. 15, 01.04.2007, p. 2006-2014.

Research output: Contribution to journalArticle

Schmidt, A, Azevedo, CF, Cheng, A, Gupta, SN, Bluemke, DA, Foo, TK, Gerstenblith, G, Weiss, RG, Marbán, E, Tomaselli, GF, Lima, JAC & Wu, KC 2007, 'Infarct tissue heterogeneity by magnetic resonance imaging identifies enhanced cardiac arrhythmia susceptibility in patients with left ventricular dysfunction', Circulation, vol. 115, no. 15, pp. 2006-2014. https://doi.org/10.1161/CIRCULATIONAHA.106.653568
Schmidt, André ; Azevedo, Clerio F. ; Cheng, Alan ; Gupta, Sandeep N. ; Bluemke, David A. ; Foo, Thomas K. ; Gerstenblith, Gary ; Weiss, Robert G. ; Marbán, Eduardo ; Tomaselli, Gordon F. ; Lima, João A C ; Wu, Katherine C. / Infarct tissue heterogeneity by magnetic resonance imaging identifies enhanced cardiac arrhythmia susceptibility in patients with left ventricular dysfunction. In: Circulation. 2007 ; Vol. 115, No. 15. pp. 2006-2014.
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AU - Schmidt, André

AU - Azevedo, Clerio F.

AU - Cheng, Alan

AU - Gupta, Sandeep N.

AU - Bluemke, David A.

AU - Foo, Thomas K.

AU - Gerstenblith, Gary

AU - Weiss, Robert G.

AU - Marbán, Eduardo

AU - Tomaselli, Gordon F.

AU - Lima, João A C

AU - Wu, Katherine C.

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N2 - BACKGROUND - The extent of the peri-infarct zone by magnetic resonance imaging (MRI) has been related to all-cause mortality in patients with coronary artery disease. This relationship may result from arrhythmogenesis in the infarct border. However, the relationship between tissue heterogeneity in the infarct periphery and arrhythmic substrate has not been investigated. In the present study, we quantify myocardial infarct heterogeneity by contrast-enhanced MRI and relate it to an electrophysiological marker of arrhythmic substrate in patients with left ventricular (LV) systolic dysfunction undergoing prophylactic implantable cardioverter defibrillator placement. METHODS AND RESULTS - Before implantable cardioverter defibrillator implantation for primary prevention of sudden cardiac death, 47 patients underwent cine and contrast-enhanced MRI to measure LV function, volumes, mass, and infarct size. A method for quantifying the heterogeneous infarct periphery and the denser infarct core is described. MRI indices were related to inducibility of sustained monomorphic ventricular tachycardia during electrophysiological or device testing. For the noninducible versus inducible patients, LV ejection fraction (30±10% versus 29±7%, P=0.79), LV end-diastolic volume (220±70 versus 228±57 mL, P=0.68), and infarct size by standard contrast-enhanced MRI definitions (P=NS) were similar. Quantification of tissue heterogeneity at the infarct periphery was strongly associated with inducibility for monomorphic ventricular tachycardia (noninducible versus inducible: 13±9 versus 19±8 g, P=0.015) and was the single significant factor in a stepwise logistic regression. CONCLUSIONS - Tissue heterogeneity is present and quantifiable within human infarcts. More extensive tissue heterogeneity correlates with increased ventricular irritability by programmed electrical stimulation. These findings support the hypothesis that anatomic tissue heterogeneity increases susceptibility to ventricular arrhythmias in patients with prior myocardial infarction and LV dysfunction.

AB - BACKGROUND - The extent of the peri-infarct zone by magnetic resonance imaging (MRI) has been related to all-cause mortality in patients with coronary artery disease. This relationship may result from arrhythmogenesis in the infarct border. However, the relationship between tissue heterogeneity in the infarct periphery and arrhythmic substrate has not been investigated. In the present study, we quantify myocardial infarct heterogeneity by contrast-enhanced MRI and relate it to an electrophysiological marker of arrhythmic substrate in patients with left ventricular (LV) systolic dysfunction undergoing prophylactic implantable cardioverter defibrillator placement. METHODS AND RESULTS - Before implantable cardioverter defibrillator implantation for primary prevention of sudden cardiac death, 47 patients underwent cine and contrast-enhanced MRI to measure LV function, volumes, mass, and infarct size. A method for quantifying the heterogeneous infarct periphery and the denser infarct core is described. MRI indices were related to inducibility of sustained monomorphic ventricular tachycardia during electrophysiological or device testing. For the noninducible versus inducible patients, LV ejection fraction (30±10% versus 29±7%, P=0.79), LV end-diastolic volume (220±70 versus 228±57 mL, P=0.68), and infarct size by standard contrast-enhanced MRI definitions (P=NS) were similar. Quantification of tissue heterogeneity at the infarct periphery was strongly associated with inducibility for monomorphic ventricular tachycardia (noninducible versus inducible: 13±9 versus 19±8 g, P=0.015) and was the single significant factor in a stepwise logistic regression. CONCLUSIONS - Tissue heterogeneity is present and quantifiable within human infarcts. More extensive tissue heterogeneity correlates with increased ventricular irritability by programmed electrical stimulation. These findings support the hypothesis that anatomic tissue heterogeneity increases susceptibility to ventricular arrhythmias in patients with prior myocardial infarction and LV dysfunction.

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KW - Cardiomyopathy

KW - Diagnosis

KW - Imaging

KW - Magnetic resonance imaging

KW - Myocardial infarction

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