OBJECTIVES: The aim of this study was to determine if noninvasive measurement of scar by contrast-enhanced magnetic resonance imaging (MRI)-based signal intensity (SI) mapping predicts ventricular tachycardia (VT) recurrence after endocardial ablation. BACKGROUND: Scar extension on voltage mapping predicts VT recurrence after ablation procedures. METHODS: A total of 46 consecutive patients with previous myocardial infarction (87% men, mean age 68 ± 9 years, mean left ventricular ejection fraction 36 ± 10%) who underwent VT substrate ablation before the implantation of a cardioverter-defibrillator were included. Before ablation, contrast-enhanced MRI was performed, and areas of endocardial and epicardial scarring and heterogeneous tissue were measured; averaged subendocardial and subepicardial signal intensities were projected onto 3-dimensional endocardial and epicardial shells in which dense scar, heterogeneous tissue, and normal tissue were differentiated. RESULTS: During a mean follow-up period of 32 ± 24 months 17 patients (37%) had VT recurrence. Patients with recurrence had larger scar and heterogeneous tissue areas on SI maps in both endocardium (81 ± 27 cm2 vs. 48 ± 21 cm2 [p = 0.001] and 53 ± 21 cm2 vs. 30 ± 15 cm2 [p = 0.001], respectively) and epicardium (76 ± 28 cm2 vs. 51 ± 29 cm2 [p = 0.032] and 59 ± 25 cm2 vs. 37 ± 19 cm2 [p = 0.008]). In the multivariate analysis, MRI endocardial scar extension was the only independent predictor of VT recurrence (hazard ratio: 1.310 [per 10 cm2]; 95% confidence interval: 1.051 to 1.632; p = 0.034). Freedom from VT recurrence was higher in patients with small endocardial scars by MRI (<65 cm2) than in those with larger scars (≥65 cm2) (85% vs. 20%, log-rank p = 0.018). CONCLUSIONS: Pre-procedure endocardial scar extension assessment by contrast-enhanced MRI predicts VT recurrence after endocardial substrate ablation. This information may be useful to select patients for ablation procedures.
OBJECTIVES: The aim of this study was to determine if noninvasive measurement of scar by contrast-enhanced magnetic resonance imaging (MRI)-based signal intensity (SI) mapping predicts ventricular tachycardia (VT) recurrence after endocardial ablation. BACKGROUND: Scar extension on voltage mapping predicts VT recurrence after ablation procedures. METHODS: A total of 46 consecutive patients with previous myocardial infarction (87% men, mean age 68 ± 9 years, mean left ventricular ejection fraction 36 ± 10%) who underwent VT substrate ablation before the implantation of a cardioverter-defibrillator were included. Before ablation, contrast-enhanced MRI was performed, and areas of endocardial and epicardial scarring and heterogeneous tissue were measured; averaged subendocardial and subepicardial signal intensities were projected onto 3-dimensional endocardial and epicardial shells in which dense scar, heterogeneous tissue, and normal tissue were differentiated. RESULTS: During a mean follow-up period of 32 ± 24 months 17 patients (37%) had VT recurrence. Patients with recurrence had larger scar and heterogeneous tissue areas on SI maps in both endocardium (81 ± 27 cm2 vs. 48 ± 21 cm2 [p = 0.001] and 53 ± 21 cm2 vs. 30 ± 15 cm2 [p = 0.001], respectively) and epicardium (76 ± 28 cm2 vs. 51 ± 29 cm2 [p = 0.032] and 59 ± 25 cm2 vs. 37 ± 19 cm2 [p = 0.008]). In the multivariate analysis, MRI endocardial scar extension was the only independent predictor of VT recurrence (hazard ratio: 1.310 [per 10 cm2]; 95% confidence interval: 1.051 to 1.632; p = 0.034). Freedom from VT recurrence was higher in patients with small endocardial scars by MRI (<65 cm2) than in those with larger scars (≥65 cm2) (85% vs. 20%, log-rank p = 0.018). CONCLUSIONS: Pre-procedure endocardial scar extension assessment by contrast-enhanced MRI predicts VT recurrence after endocardial substrate ablation. This information may be useful to select patients for ablation procedures.
Authors: Jens Cosedis Nielsen; Yenn-Jiang Lin; Marcio Jansen de Oliveira Figueiredo; Alireza Sepehri Shamloo; Alberto Alfie; Serge Boveda; Nikolaos Dagres; Dario Di Toro; Lee L Eckhardt; Kenneth Ellenbogen; Carina Hardy; Takanori Ikeda; Aparna Jaswal; Elizabeth Kaufman; Andrew Krahn; Kengo Kusano; Valentina Kutyifa; Han S Lim; Gregory Y H Lip; Santiago Nava-Townsend; Hui-Nam Pak; Gerardo Rodríguez Diez; William Sauer; Anil Saxena; Jesper Hastrup Svendsen; Diego Vanegas; Marmar Vaseghi; Arthur Wilde; T Jared Bunch; Alfred E Buxton; Gonzalo Calvimontes; Tze-Fan Chao; Lars Eckardt; Heidi Estner; Anne M Gillis; Rodrigo Isa; Josef Kautzner; Philippe Maury; Joshua D Moss; Gi-Byung Nam; Brian Olshansky; Luis Fernando Pava Molano; Mauricio Pimentel; Mukund Prabhu; Wendy S Tzou; Philipp Sommer; Janice Swampillai; Alejandro Vidal; Thomas Deneke; Gerhard Hindricks; Christophe Leclercq Journal: Europace Date: 2020-08-01 Impact factor: 5.214
Authors: Daniel G León; Mariña López-Yunta; José Manuel Alfonso-Almazán; Manuel Marina-Breysse; Jorge G Quintanilla; Javier Sánchez-González; Carlos Galán-Arriola; Francisco Castro-Núñez; Juan José González-Ferrer; Borja Ibáñez; Julián Pérez-Villacastín; Nicasio Pérez-Castellano; Valentín Fuster; José Jalife; Mariano Vázquez; Jazmín Aguado-Sierra; David Filgueiras-Rama Journal: Europace Date: 2019-05-01 Impact factor: 5.214
Authors: Susana Merino-Caviedes; Lilian K Gutierrez; José Manuel Alfonso-Almazán; Santiago Sanz-Estébanez; Lucilio Cordero-Grande; Jorge G Quintanilla; Javier Sánchez-González; Manuel Marina-Breysse; Carlos Galán-Arriola; Daniel Enríquez-Vázquez; Carlos Torres; Gonzalo Pizarro; Borja Ibáñez; Rafael Peinado; Jose Luis Merino; Julián Pérez-Villacastín; José Jalife; Mariña López-Yunta; Mariano Vázquez; Jazmín Aguado-Sierra; Juan José González-Ferrer; Nicasio Pérez-Castellano; Marcos Martín-Fernández; Carlos Alberola-López; David Filgueiras-Rama Journal: Sci Rep Date: 2021-09-28 Impact factor: 4.379