Published Online
on March 23, 2009

A more recent version of this article appeared on May 1, 2009

This Article Full Text (PDF) All Versions of this Article: 2/3/183    most recent CIRCIMAGING.108.826529v1 Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Roes, S. D. Articles by Bax, J. J. Search for Related Content PubMed PubMed Citation Articles by Roes, S. D. Articles by Bax, J. J. Related Collections Arrhythmias, clinical electrophysiology, drugs Chronic ischemic heart disease Ablation/ICD/surgery CT and MRI

Original Article

Infarct Tissue Heterogeneity Assessed with Contrast-Enhanced Magnetic Resonance Imaging Predicts Spontaneous Ventricular Arrhythmia in Patients with Ischemic Cardiomyopathy and Implantable Cardioverter-Defibrillator

Stijntje Dorien Roes¹; C. Jan Willem Borleffs; Rob J. van der Geest; Jos J.M. Westenberg; Nina Ajmone Marsan; Theodorus A.M. Kaandorp; Johan H.C. Reiber; Katja Zeppenfeld; Hildo J. Lamb; Albert de Roos; Martin J. Schalij and Jeroen J. Bax

Leiden University Medical Center, Leiden, The Netherlands

¹ E-mail: s.d.roes{at}lumc.nl

Background—The relation between infarct tissue heterogeneity on contrast-enhanced magnetic resonance imaging (MRI) and the occurrence of spontaneous ventricular arrhythmia (VA) (or sudden cardiac death (SCD)) 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 VA with subsequent implantable cardioverter-defibrillator (ICD) therapy (as surrogate of SCD) in patients with previous myocardial infarction (MI).

Methods and Results—Ninety-one patients (65±11 years) with previous MI scheduled for ICD implantation underwent cine-MRI to evaluate left ventricular (LV) 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 2.1-20.3). Multivariable Cox proportional hazards analysis revealed that infarct gray zone was the strongest predictor of the occurrence of spontaneous VA with subsequent ICD therapy (hazard ratio 1.49/10g, confidence interval 1.01-2.20, chi-square 4.0, p=0.04).

Conclusions—Infarct tissue heterogeneity on contrast-enhanced MRI is the strongest predictor of spontaneous VA with subsequent ICD therapy (as surrogate of SCD) among other clinical and MRI variables e.g. total infarct size, LV function and volumes, in patients with previous MI.

Key Words: arrhythmia • death, sudden (if surviving, use heart arrest) • magnetic resonance imaging • myocardial infarction

This article has been cited by other articles:

				S. Kelle, S. D. Roes, C. Klein, T. Kokocinski, A. de Roos, E. Fleck, J. J. Bax, and E. Nagel Prognostic value of myocardial infarct size and contractile reserve using magnetic resonance imaging. J. Am. Coll. Cardiol., November 3, 2009; 54(19): 1770 - 1777. [Abstract] [Full Text] [PDF]