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Original Articles

Infarct Tissue Heterogeneity Assessed With Contrast-Enhanced MRI Predicts Spontaneous Ventricular Arrhythmia in Patients With Ischemic Cardiomyopathy and Implantable Cardioverter-Defibrillator

Stijntje D. Roes, MD; C. Jan Willem Borleffs, MD; Rob J. van der Geest, MSc; Jos J.M. Westenberg, PhD; Nina Ajmone Marsan, MD; Theodorus A.M. Kaandorp, MD; Johan H.C. Reiber, PhD; Katja Zeppenfeld, MD; Hildo J. Lamb, MD; Albert de Roos, MD; Martin J. Schalij, MD and Jeroen J. Bax, MD

From the Department of Radiology (S.D.R., J.J.M.W., T.A.M.K., H.J.L., A.d.R.), the Department of Cardiology (C.J.W.B., N.A.M., K.Z., M.J.S., J.J.B.), and the Division of Image Processing (R.J.v.d.G., J.H.C.R.), Leiden University Medical Center, Leiden, The Netherlands.

Correspondence to Stijntje D. Roes, MD, Department of Radiology, LUMC, PO Box 9600, Leiden, The Netherlands. E-mail s.d.roes{at}lumc.nl

Received October 8, 2008; accepted March 19, 2009.

Background— The relation between infarct tissue heterogeneity on contrast-enhanced MRI and the occurrence of spontaneous ventricular arrhythmia (or sudden cardiac death) is unknown. Therefore, the study purpose was to evaluate the predictive value of infarct tissue heterogeneity assessed with contrast-enhanced MRI on the occurrence of spontaneous ventricular arrhythmia with subsequent implantable cardioverter-defibrillator (ICD) therapy (as surrogate of sudden cardiac death) in patients with previous myocardial infarction.

Methods and Results— Ninety-one patients (age, 65±11 years) with previous myocardial infarction scheduled for ICD implantation underwent cine MRI to evaluate left ventricular function and volumes and contrast-enhanced MRI for characterization of scar tissue (infarct gray zone as measure of infarct tissue heterogeneity, infarct core, and total infarct size). Appropriate ICD therapy was documented in 18 patients (20%) during a median follow-up of 8.5 months (interquartile range, 2.1 to 20.3). Multivariable Cox proportional hazards analysis revealed that infarct gray zone was the strongest predictor of the occurrence of spontaneous ventricular arrhythmia with subsequent ICD therapy (hazard ratio, 1.49/10 g; CI, 1.01 to 2.20; ²=4.0; P=0.04).

Conclusions— Infarct tissue heterogeneity on contrast-enhanced MRI is the strongest predictor of spontaneous ventricular arrhythmia with subsequent ICD therapy (as surrogate of sudden cardiac death) among other clinical and MRI variables, that is, total infarct size and left ventricular function and volumes, in patients with previous myocardial infarction.

Key Words: MRI • myocardial infarction • sudden death • arrhythmia

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