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首页> 外文期刊>JACC. Cardiovascular imaging. >Prediction of life-threatening arrhythmic events in patients with chronic myocardial infarction by contrast-enhanced CMR.
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Prediction of life-threatening arrhythmic events in patients with chronic myocardial infarction by contrast-enhanced CMR.

机译：对比剂增强型CMR预测慢性心肌梗死患者危及生命的心律失常事件。

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OBJECTIVES: We hypothesized that infarct transmurality assessed with late gadolinium enhancement cardiac magnetic resonance (LGE-CMR) predicts arrhythmic events in patients with chronic myocardial infarction. BACKGROUND: Patients with decreased left ventricular function due to chronic myocardial infarction are at increased risk for life-threatening arrhythmias related to infarcted tissue. LGE-CMR accurately detects infarct morphology. METHODS: We prospectively enrolled 52 patients with chronic myocardial infarction referred for primary preventive implantable cardioverter-defibrillator (ICD) implantation following MADIT (Multicenter Automatic Defibrillator Implantation Trial) study criteria. Using LGE-CMR, left ventricular volumes, function, and infarct morphology were assessed including calculation of total and relative infarct mass, infarct border, infarct border zone, and infarct transmurality. RESULTS: Patients were followed for 1,235 +/- 341 days. The primary combined endpoint including appropriate device therapy (ICD discharge or antitachycardia pacing) or death from cardiac cause occurred in 16 individuals resulting in an annual event rate of 4.7%. Six patients received an appropriate shock, 7 patients received recurrent appropriate antitachycardia pacing for sustained ventricular tachycardia, and 3 patients died of cardiac cause. There was a significant association to relative infarct mass (38 +/- 8% vs. 28 +/- 14%, p = 0.02), infarct transmurality (24 +/- 8 g vs. 16 +/- 12 g, p = 0.02), and relative infarct transmurality (RIT) (63 +/- 12% vs. 48 +/- 23%, p = 0.01). In separate logistic regression models, no variable emerged as significant when combined with RIT. As a single effect, RIT emerged as a predictor of the primary endpoint (p = 0.02). A RIT cutoff at 43% resulted in a sensitivity of 88%, a specificity of 50%, a positive predictive value of 44%, and a negative predictive value of 90%. CONCLUSIONS: In patients with chronic myocardial infarction scheduled for primary preventive ICD implantation, infarct transmurality as defined by LGE-CMR identifies a subgroup with increased risk for life-threatening arrhythmias and cardiac death.
机译：目的：我们假设以晚期g增强心脏磁共振（LGE-CMR）评估的梗死透壁性可预测慢性心肌梗死患者的心律失常事件。背景：由于慢性心肌梗塞导致左心室功能下降的患者发生与梗死组织相关的危及生命的心律失常的风险增加。 LGE-CMR可以准确检测梗死形态。方法：我们前瞻性地招募了52名接受MADIT（多中心自动除纤颤器植入试验）研究标准的主要预防性植入式心脏复律除颤器（ICD）植入的慢性心肌梗死患者。使用LGE-CMR评估左心室容积，功能和梗塞形态，包括计算总梗塞和相对梗塞质量，梗塞边界，梗塞边界区和梗塞透壁率。结果：患者随访1,235 +/- 341天。包括适当的器械治疗（ICD放电或抗心动过速起搏）或因心脏原因导致死亡的主要联合终点发生在16位个体中，导致每年事件发生率为4.7％。 6例患者接受了适当的电击，7例患者因持续性室性心动过速而反复接受适当的抗心动过速起搏，3例因心脏原因死亡。与梗死相对质量（38 +/- 8％vs. 28 +/- 14％，p = 0.02），梗死透壁性（24 +/- 8 g vs. 16 +/- 12 g，p = 0.02）和相对梗死透壁率（RIT）（63 +/- 12％vs. 48 +/- 23％，p = 0.01）。在单独的逻辑回归模型中，与RIT结合使用时，没有变量显示为显着。作为一个单一的影响，RIT成为主要终点的预测指标（p = 0.02）。 RIT临界值为43％，灵敏度为88％，特异性为50％，阳性预测值为44％，阴性预测值为90％。结论：在计划进行一级预防性ICD植入的慢性心肌梗死患者中，LGE-CMR定义的梗死透壁性可确定为危及生命的心律失常和心源性死亡风险增加的亚组。

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